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Illinois rates for HCPCS L5704

Custom Shaped Protective Cover Below Knee

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$373.69 / $373.69 / $373.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$297.08 / $373.69 / $582.41
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$901.53 / $1,525.23 / $6,496.32
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$573.80 / $573.80 / $573.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$394.91 / $394.91 / $820.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.27 / $394.90 / $875.25
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$636.96 / $778.59 / $981.51
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$981.51 / $981.51 / $981.51
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.21 / $608.88 / $639.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$279.41 / $376.66 / $646.60