go back

Michigan rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$431.18 / $431.18 / $431.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.60 / $431.18 / $431.18
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,142.76 / $2,276.81 / $4,146.82
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$717.26 / $755.01 / $1,019.26
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$418.18 / $458.27 / $490.76
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$604.01 / $604.01 / $604.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$394.91 / $394.91 / $394.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$394.90 / $394.91 / $875.25
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$431.18 / $545.60 / $545.60
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$379.58 / $545.60 / $792.76
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$458.14 / $558.71 / $642.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$262.75 / $360.94 / $533.60