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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
$363.08 / $446.68 / $676.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.11 / $398.11 / $398.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $288.40 / $416.87
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$204.17 / $660.69 / $758.58
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $758.58 / $2,238.72
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$645.65 / $758.58 / $794.33
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $758.58 / $776.25
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$204.17 / $204.17 / $741.31
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $398.11 / $691.83
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $416.87 / $478.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $389.05 / $1,513.56