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Vermont rates for HCPCS L5705

Custom shaped protective cover, above knee (AK)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $676.08 / $794.33
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,047.13 / $1,047.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $891.25 / $954.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $660.69 / $891.25
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,230.27 / $1,479.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$602.56 / $741.31 / $870.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $977.24 / $2,754.23