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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
$379.58 / $379.58 / $2,111.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.64 / $379.58 / $2,111.69
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.33 / $512.33 / $512.33
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.24 / $1,056.42 / $2,323.27
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$368.32 / $384.00 / $702.16
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.00 / $866.53 / $1,547.37
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $971.12 / $2,262.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$342.34 / $394.91 / $394.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.27 / $288.27 / $420.99
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$271.39 / $325.68 / $805.09
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$439.14 / $512.33 / $1,112.49
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,532.67 / $3,476.53 / $3,476.53
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,622.91 / $3,622.91 / $5,120.10
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,931.77 / $1,931.77 / $1,931.77
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$203.55 / $635.77 / $741.81
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.27 / $394.90 / $696.64
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,381.43 / $1,381.43 / $1,381.43
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$271.39 / $461.38 / $585.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$300.02 / $361.88 / $738.43