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Washington, DC rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$375.79 / $375.79 / $375.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$375.79 / $375.79 / $375.79
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$378.00 / $395.10 / $481.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.27 / $288.27 / $288.27
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$458.27 / $458.27 / $1,399.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.49 / $351.73 / $498.29