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North Dakota rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$517.09 / $517.09 / $517.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$517.09 / $632.39 / $632.39
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$664.53 / $785.71 / $805.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$875.25 / $884.00 / $1,111.57
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$281.64 / $586.86 / $3,305.62
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$279.39 / $472.94 / $574.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$210.20 / $315.29 / $566.29