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North Carolina rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$478.84 / $478.84 / $971.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$314.85 / $478.84 / $478.84
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$586.07 / $954.32 / $1,175.27
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$366.71 / $482.51 / $482.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$394.91 / $394.91 / $397.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.27 / $394.91 / $875.25
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$203.55 / $478.84 / $724.49
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$362.00 / $362.00 / $452.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$819.20 / $819.20 / $1,259.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$262.75 / $320.95 / $485.86
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,268.42 / $3,476.53 / $3,476.53
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,622.91 / $3,622.91 / $5,120.10