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Tennessee rates for HCPCS L5694

Addition to lower extremity, above knee (AK), pelvic control belt, padded and lined

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$92.52 / $94.33 / $94.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.52 / $94.75 / $162.06
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.74 / $195.97 / $195.97
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$116.39 / $140.85 / $140.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.82 / $102.82 / $140.85
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$374.15 / $1,167.33 / $1,379.02
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,514.88 / $1,551.24 / $1,633.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.42 / $108.63 / $163.66