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Arizona rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$287.80 / $329.36 / $478.84
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$192.15 / $694.15 / $1,254.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$480.38 / $640.50 / $872.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$394.91 / $394.91 / $394.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.27 / $288.27 / $875.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$203.55 / $489.05 / $3,305.62
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$284.95 / $315.29 / $485.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$284.95 / $315.29 / $474.94