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Vermont rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $380.19 / $446.68
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $575.44 / $575.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.11 / $398.11 / $524.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $288.40 / $416.87
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $660.69 / $851.14
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$363.08 / $416.87 / $501.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $537.03 / $1,479.11