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Idaho rates for HCPCS L5704

Custom Shaped Protective Cover Below Knee

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$445.14 / $615.24 / $615.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$394.91 / $394.91 / $459.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.27 / $394.90 / $420.99
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$203.55 / $515.57 / $731.90
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$658.71 / $695.31 / $731.90
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $540.14 / $643.28
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$640.88 / $714.75 / $1,072.13
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.33 / $512.33 / $768.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$291.52 / $315.29 / $499.22