go back

New Mexico rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$354.87 / $354.87 / $354.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.87 / $484.43 / $2,111.69
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$385.41 / $513.88 / $612.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$394.91 / $394.91 / $394.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.27 / $394.90 / $394.91
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$753.86 / $942.33 / $1,413.49
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$203.55 / $203.55 / $483.43
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.27 / $394.91 / $766.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$291.52 / $315.29 / $475.05