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Maine rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$311.58 / $480.29 / $480.29
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$634.26 / $821.74 / $1,523.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$384.00 / $403.30 / $535.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$394.91 / $394.91 / $524.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.27 / $288.27 / $394.91
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$577.38 / $577.38 / $577.38
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$401.54 / $480.29 / $480.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$237.18 / $355.77 / $818.16