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Indiana rates for HCPCS L5705

Custom shaped protective cover, above knee (AK)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$658.76 / $658.76 / $1,384.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$568.97 / $658.76 / $685.11
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,093.53 / $1,238.88 / $1,384.22
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$669.63 / $686.95 / $947.99
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$977.13 / $1,453.43 / $1,937.91
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,176.58 / $1,522.64 / $1,868.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$895.43 / $895.43 / $1,384.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$653.66 / $895.43 / $1,347.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$370.82 / $690.57 / $924.88