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Tennessee rates for HCPCS L5697

Addition to lower extremity, above knee (AK) or knee disarticulation, pelvic band

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.94 / $41.75 / $41.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.94 / $41.93 / $71.70
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.41 / $86.72 / $86.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.50 / $60.21 / $60.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.95 / $43.95 / $60.21
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$163.49 / $510.07 / $610.23
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$638.51 / $653.85 / $722.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.04 / $48.07 / $72.43