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Tennessee rates for HCPCS L5858

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,549.93 / $9,549.93 / $16,982.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,549.93 / $10,715.19 / $19,054.61
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,982.44 / $16,982.44 / $18,197.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,454.40 / $14,454.40 / $14,454.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,715.19 / $10,715.19 / $14,454.40
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104,712.85 / $104,712.85 / $104,712.85
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112,201.85 / $165,958.69 / $165,958.69
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,762.47 / $13,182.57 / $15,848.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,585.78 / $10,964.78 / $15,135.61