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California rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.19 / $380.19 / $3,162.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $380.19 / $2,818.38
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $489.78 / $489.78
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.40 / $363.08 / $1,548.82
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $380.19 / $812.83
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $1,288.25 / $1,698.24
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $1,380.38 / $2,344.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$338.84 / $398.11 / $398.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $288.40 / $398.11
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $338.84 / $891.25
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $676.08 / $1,174.90
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,467.37 / $3,467.37 / $3,467.37
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,630.78 / $5,128.61 / $5,128.61
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $933.25 / $933.25
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$234.42 / $660.69 / $933.25
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $288.40 / $691.83
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $1,380.38 / $1,380.38
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $407.38 / $676.08
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.48 / $416.87 / $851.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $380.19 / $741.31