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Tennessee rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$273.36 / $278.72 / $278.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$273.36 / $281.64 / $504.28
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$482.51 / $482.51 / $482.51
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$383.31 / $579.02 / $579.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$343.86 / $394.91 / $394.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.27 / $288.27 / $394.91
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,059.50 / $3,305.62 / $3,476.53
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,622.91 / $3,622.91 / $5,120.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.97 / $320.95 / $475.05