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Wisconsin rates for HCPCS L5705

Custom Shaped Protective Cover Above Knee

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$698.29 / $698.29 / $698.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.88 / $698.29 / $1,159.42
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,384.22 / $1,522.64 / $2,519.28
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,245.79 / $1,287.32 / $1,702.59
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$995.80 / $2,962.23 / $2,962.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$895.43 / $2,862.08 / $5,777.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$653.66 / $2,005.78 / $2,619.75
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$359.09 / $1,047.44 / $1,591.85
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$792.56 / $1,201.58 / $1,661.06
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$621.60 / $1,384.22 / $5,814.95
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$611.16 / $837.88 / $1,507.24
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $807.50
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$359.09 / $1,047.44 / $1,591.85
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$792.56 / $1,201.58 / $1,661.06
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,384.22 / $2,127.88 / $3,337.30
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$895.43 / $2,703.56 / $5,814.95
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$653.66 / $895.43 / $6,083.01
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,384.22 / $1,384.22 / $1,384.22
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,105.26 / $1,384.22 / $1,384.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$502.73 / $830.53 / $1,384.22