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Washington rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Facilitymedian $724 · 10th–90th $479–$1,5850%20%10th90th$724Professionalmedian $479 · 10th–90th $288–$1,0470%10%20%10th90th$479$1.0$5.0$20.0$100.0$500.0$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$478.63 / $478.63 / $1,122.02
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$281.84 / $380.19 / $630.96
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$630.96 / $707.95 / $707.95
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$630.96 / $630.96 / $812.83
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 / $398.11
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$398.11 / $891.25 / $2,041.74
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$398.11 / $851.14 / $1,479.11
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $501.19 / $616.60
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$575.44 / $707.95 / $724.44
Pacific Source
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$660.69 / $724.44 / $724.44
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$645.65 / $1,071.52 / $1,479.11
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$602.56 / $602.56 / $707.95
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$707.95 / $707.95 / $707.95
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$630.96 / $630.96 / $812.83
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$416.87 / $1,023.29 / $1,023.29
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$295.12 / $426.58 / $602.56
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$338.84 / $630.96 / $1,122.02