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Vermont rates for HCPCS L5704

Custom Shaped Protective Cover Below Knee

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$348.00 / $348.00 / $401.54
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$576.95 / $576.95 / $576.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$394.91 / $394.91 / $524.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.27 / $394.90 / $420.99
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$394.91 / $394.91 / $524.14
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.27 / $394.90 / $420.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$237.18 / $475.05 / $824.41