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Oklahoma rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$276.01 / $276.01 / $276.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$276.01 / $315.44 / $318.42
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$546.80 / $546.80 / $546.80
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$459.26 / $563.29 / $563.29
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
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$203.55 / $386.37 / $3,305.62
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$210.20 / $416.64 / $651.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$210.20 / $315.29 / $474.94