go back

Delaware rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $316.23 / $1,412.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.11 / $398.11 / $398.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $288.40 / $288.40
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $707.95 / $707.95
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.50 / $363.08 / $478.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $380.19 / $524.81