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Massachusetts rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$311.58 / $311.58 / $311.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$311.58 / $311.58 / $540.80
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$638.04 / $2,012.38 / $3,476.53
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$315.29 / $514.22 / $696.42
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$412.48 / $412.48 / $1,225.07
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$513.66 / $599.42 / $599.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$394.91 / $412.48 / $499.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.27 / $394.90 / $875.25
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$577.38 / $577.38 / $606.25
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.94 / $512.94 / $512.94
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,532.67 / $3,476.53 / $3,476.53
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$278.57 / $381.19 / $696.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.72 / $381.19 / $682.68