go back

Iowa rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$517.09 / $632.39 / $632.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$268.00 / $379.58 / $582.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$394.91 / $394.91 / $820.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$394.91 / $875.25 / $1,094.06
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$643.35 / $755.01 / $841.34
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$475.87 / $960.10 / $3,305.62
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$355.85 / $453.97 / $1,019.54
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$818.44 / $820.84 / $983.79
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$672.26 / $958.85 / $1,568.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$355.85 / $376.10 / $877.95
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$731.30 / $731.30 / $731.30
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$577.73 / $731.30 / $731.30