go back

New Jersey rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$250.88 / $250.88 / $250.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$250.88 / $308.68 / $475.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$394.91 / $394.91 / $682.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.27 / $288.27 / $597.78
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$623.67 / $628.07 / $894.31
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$666.68 / $682.68 / $682.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$307.82 / $340.58 / $626.73