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Tennessee rates for HCPCS L5701

Replacement, socket, above knee (AK)/knee disarticulation, including attachment plate, molded to patient model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,737.80 / $1,737.80 / $3,162.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $2,089.30 / $3,630.78
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,162.28 / $3,162.28 / $3,801.89
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,090.30 / $3,090.30 / $3,311.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,570.40 / $2,570.40 / $2,570.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.09 / $1,862.09 / $2,570.40
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25,703.96 / $25,703.96 / $25,703.96
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26,302.68 / $30,902.95 / $30,902.95
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,584.89 / $2,691.53 / $3,235.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $2,041.74 / $3,090.30