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New Hampshire rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Facilitymedian $724 · 10th–90th $398–$8710%20%40%10th90th$724Professionalmedian $479 · 10th–90th $309–$6610%20%10th90th$479$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
Facility
Modifier
Typical Low / Median / Typical High
$398.11 / $398.11 / $478.63
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$295.12 / $398.11 / $616.60
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$724.44 / $776.25 / $891.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$380.19 / $380.19 / $398.11
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$398.11 / $398.11 / $524.81
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$288.40 / $288.40 / $398.11
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$630.96 / $630.96 / $1,148.15
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$194.98 / $436.52 / $478.63
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$288.40 / $478.63 / $630.96
Well Sense
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$691.83 / $691.83 / $1,023.29