go back

Utah rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Facilitymedian $398 · 10th–90th $204–$7080%20%40%10th90th$398Professionalmedian $513 · 10th–90th $204–$3,1620%5%10%10th90th$513$50.0$100.0$200.0$500.0$1.0K$2.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$204.17 / $204.17 / $204.17
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$204.17 / $380.19 / $3,162.28
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$398.11 / $398.11 / $398.11
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$288.40 / $288.40 / $407.38
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $524.81 / $676.08
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$676.08 / $707.95 / $707.95
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$512.86 / $512.86 / $794.33
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$707.95 / $707.95 / $741.31
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$512.86 / $724.44 / $891.25
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$263.03 / $416.87 / $478.63
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$245.47 / $316.23 / $562.34