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Tennessee rates for HCPCS L5856

Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing and stance phase, includes electronic sensor(s), any type

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,380.50 / $12,623.28 / $12,623.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12,380.50 / $12,623.28 / $21,686.54
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21,852.92 / $21,852.92 / $21,852.92
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17,360.24 / $26,223.50 / $26,223.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16,200.25 / $16,200.25 / $16,200.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11,826.18 / $11,826.18 / $16,200.25
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39,335.25 / $134,932.92 / $134,932.92
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$145,801.04 / $145,801.04 / $213,102.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,690.83 / $14,536.25 / $19,793.02