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New York rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$250.88 / $297.08 / $549.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$250.88 / $311.58 / $430.40
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$682.68 / $696.33 / $1,365.36
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$384.00 / $384.00 / $1,063.68
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$528.96 / $568.77 / $568.77
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$568.77 / $568.77 / $568.77
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 / $288.27 / $394.91
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$319.00 / $682.68 / $1,536.03
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$383.80 / $512.01 / $1,228.82
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$479.75 / $479.75 / $479.75
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$410.43 / $436.09 / $568.77
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$553.74 / $553.74 / $553.74
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$394.91 / $394.91 / $682.68
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.27 / $394.91 / $1,017.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$227.05 / $409.61 / $588.41
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$410.43 / $410.43 / $426.51
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$410.43 / $410.43 / $479.75