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Montana rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Facilitymedian $692 · 10th–90th $468$8710%20%10th90th$692Professionalmedian $479 · 10th–90th $234$8130%10%10th90th$479$100.0$200.0$500.0$1.0K$2.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$234.42 / $446.68 / $616.60
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$691.83 / $691.83 / $691.83
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$398.11 / $741.31 / $741.31
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$398.11 / $741.31 / $741.31
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$549.54 / $691.83 / $1,348.96
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$549.54 / $691.83 / $1,348.96
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$346.74 / $660.69 / $912.01
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $562.34 / $741.31
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$416.87 / $478.63 / $501.19
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$281.84 / $316.23 / $489.78