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Tennessee rates for HCPCS L5703

Ankle, Symes, molded to patient model, socket without solid ankle cushion heel (SACH) foot, replacement only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,148.15 / $1,148.15 / $2,041.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $1,348.96 / $2,290.87
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,041.74 / $2,041.74 / $2,187.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,137.96 / $2,137.96 / $2,137.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,548.82 / $1,548.82 / $2,137.96
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,803.84 / $13,803.84 / $13,803.84
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,848.93 / $20,892.96 / $20,892.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.99 / $1,659.59 / $1,995.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,318.26 / $1,905.46