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Rhode Island rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$311.58 / $379.58 / $422.95
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,008.26 / $1,361.80 / $1,612.21
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$341.31 / $401.54 / $644.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$394.91 / $394.91 / $412.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.27 / $394.90 / $394.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$278.57 / $407.26 / $592.95