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Tennessee rates for HCPCS L5705

Custom shaped protective cover, above knee (AK)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $489.78 / $870.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $616.60 / $977.24
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $870.96 / $1,047.13
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $870.96 / $912.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $891.25 / $891.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $660.69 / $891.25
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,754.40 / $5,754.40 / $5,754.40
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,165.95 / $9,332.54 / $9,332.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$426.58 / $741.31 / $891.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $562.34 / $831.76