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Pennsylvania rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Facilitymedian $851 · 10th–90th $316$1,2300%20%10th90th$851Professionalmedian $355 · 10th–90th $275$5620%20%40%10th90th$355$1.0$10.0$100.0$1.0K$10.0K

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
$316.23 / $1,230.27 / $1,230.27
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$275.42 / $346.74 / $562.34
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,011.87 / $8,511.38 / $77,624.71
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$398.11 / $575.44 / $724.44
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$398.11 / $398.11 / $630.96
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$288.40 / $288.40 / $398.11
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$645.65 / $912.01 / $1,318.26
Geisinger
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$724.44 / $724.44 / $724.44
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$426.58 / $489.78 / $724.44
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$316.23 / $316.23 / $316.23
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$275.42 / $354.81 / $537.03
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.60 / $933.25 / $1,348.96
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$489.78 / $489.78 / $676.08
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$467.74 / $489.78 / $691.83
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$281.84 / $851.14 / $977.24
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$295.12 / $389.05 / $691.83