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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
$9,584.93 / $9,772.87 / $9,772.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,568.04 / $9,772.87 / $16,789.61
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13,440.20 / $20,302.09 / $20,302.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,513.81 / $14,513.81 / $14,513.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,595.08 / $10,595.08 / $14,513.81
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30,453.15 / $104,478.94 / $104,478.94
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112,957.80 / $112,957.80 / $164,238.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,502.59 / $11,253.89 / $15,408.48