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Tennessee rates for HCPCS K0195

Elevating Leg Rests Pair (For Use With Capped Rental Wheelchair Base) (Special Coverage Instructions Apply. See Cim: 60-9)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.15 / $99.15 / $99.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.59 / $102.00 / $120.77
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $60.00 / $60.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$152.38 / $162.21 / $191.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$88.70 / $88.70 / $98.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.40 / $75.40 / $157.50
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $196.86 / $206.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.26 / $13.80 / $129.76