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Pennsylvania rates for HCPCS L5705

Custom shaped protective cover, above knee (AK)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.44 / $2,238.72 / $2,238.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $660.69 / $1,096.48
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $870.96 / $870.96
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,011.87 / $8,511.38 / $77,624.71
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $1,288.25 / $1,288.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $891.25 / $1,288.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $660.69 / $891.25
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,659.59 / $2,398.83
Geisinger
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,318.26 / $1,318.26 / $1,318.26
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $891.25 / $1,318.26
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $870.96 / $912.01
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.44 / $575.44 / $2,238.72
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $660.69 / $1,148.15
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,041.74 / $2,041.74 / $2,041.74
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $1,698.24 / $2,454.71
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$616.60 / $616.60 / $1,230.27
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $616.60 / $1,318.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $1,513.56 / $1,819.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $691.83 / $1,174.90