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Louisiana rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$347.68 / $369.07 / $524.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$329.36 / $369.07 / $534.89
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$514.67 / $514.67 / $514.67
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$559.91 / $956.54 / $1,344.55
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$381.85 / $456.74 / $456.74
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
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 / $394.90 / $394.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$210.20 / $331.09 / $485.86