go back

Tennessee rates for HCPCS L5857

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,393.06 / $4,479.20 / $4,479.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,393.06 / $4,479.20 / $7,695.18
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,160.04 / $9,305.06 / $9,305.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,652.12 / $6,652.12 / $6,652.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,856.05 / $4,856.05 / $6,652.12
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,957.58 / $48,028.27 / $48,028.27
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51,669.39 / $51,669.39 / $76,237.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,438.66 / $5,157.99 / $7,091.00