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Alaska rates for HCPCS L5705

Custom shaped protective cover, above knee (AK)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,086.84 / $1,086.84 / $1,086.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$895.43 / $895.43 / $895.43
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$653.66 / $895.43 / $954.57
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$359.09 / $359.09 / $359.09
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,141.51 / $1,179.10 / $1,861.76
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$359.09 / $359.09 / $895.43
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$653.66 / $895.43 / $1,317.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$619.21 / $619.21 / $1,186.81