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Missouri rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$340.92 / $504.28 / $520.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$340.92 / $390.64 / $710.26
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$499.97 / $499.97 / $499.97
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$746.22 / $783.53 / $3,444.55
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$373.42 / $384.00 / $603.72
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 / $288.27 / $420.99
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$340.92 / $601.39 / $3,305.62
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$262.75 / $398.88 / $666.97
Qualchoice
Facility/Professional
Professional
Modifier
Low / Median / High Price
$591.84 / $591.84 / $591.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$262.75 / $372.28 / $498.60