go back

Minnesota rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$632.39 / $632.39 / $632.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.39 / $582.41 / $632.39
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$646.77 / $755.01 / $1,051.31
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$604.01 / $717.26 / $755.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$394.91 / $2,329.81 / $6,470.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$875.25 / $927.77 / $1,111.57
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,383.18 / $2,235.34 / $5,095.14
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$875.25 / $875.25 / $900.80
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$209.66 / $755.01 / $3,305.62
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$210.20 / $352.75 / $758.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$210.20 / $352.08 / $758.16