go back

Virginia rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$371.83 / $371.83 / $375.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$304.18 / $371.83 / $379.58
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$705.03 / $705.03 / $748.74
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$384.00 / $384.00 / $491.50
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$378.00 / $378.00 / $481.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$376.86 / $394.91 / $394.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.27 / $288.27 / $394.91
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$493.52 / $634.53 / $846.04
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$203.55 / $435.04 / $802.56
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$362.00 / $926.06 / $1,174.35
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$386.27 / $529.84 / $881.29
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$386.27 / $529.84 / $881.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$317.89 / $351.73 / $504.61