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Connecticut rates for HCPCS L5704

Custom Shaped Protective Cover Below Knee

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$346.60 / $346.60 / $346.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.64 / $311.58 / $346.60
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$552.67 / $713.13 / $815.89
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$384.00 / $384.00 / $403.30
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 / $394.91
ConnectiCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$463.53 / $463.53 / $463.53
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$443.74 / $463.53 / $628.07
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.94 / $512.94 / $512.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$271.51 / $355.77 / $482.48