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Nebraska rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$475.87 / $475.87 / $475.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$475.87 / $475.87 / $561.11
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.86 / $721.44 / $728.73
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$394.91 / $820.84 / $820.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$394.91 / $820.84 / $1,265.74
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$378.27 / $808.98 / $3,305.62
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$284.10 / $420.39 / $620.46
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$818.44 / $820.84 / $1,034.23
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$682.51 / $960.10 / $1,691.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$284.10 / $416.64 / $485.86