go back

Indiana rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$359.32 / $359.32 / $755.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$318.42 / $359.32 / $373.69
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$528.51 / $528.51 / $528.51
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$596.46 / $675.73 / $755.01
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$368.32 / $384.00 / $529.91
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$546.85 / $804.19 / $1,057.01
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$641.76 / $830.51 / $1,019.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$394.91 / $394.91 / $755.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.27 / $394.91 / $774.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$210.20 / $376.66 / $500.05