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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
$1,754.81 / $1,789.22 / $1,789.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,754.81 / $1,807.59 / $3,216.10
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,097.42 / $3,097.42 / $3,097.42
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,460.62 / $3,716.90 / $3,716.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,207.38 / $2,550.04 / $2,550.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,861.53 / $1,861.53 / $2,550.04
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,775.88 / $21,140.73 / $25,846.18
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26,362.41 / $26,362.41 / $31,152.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,373.57 / $2,060.36 / $3,067.56