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Alaska rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$679.29 / $679.29 / $679.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$394.91 / $394.91 / $394.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.27 / $394.91 / $420.99
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$203.55 / $203.55 / $203.55
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$695.31 / $736.95 / $1,163.60
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$203.55 / $203.55 / $394.91
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.27 / $420.99 / $718.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$374.93 / $387.01 / $741.76