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Wisconsin rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Facilitymedian $776 · 10th–90th $631$1,4130%20%40%10th90th$776Professionalmedian $513 · 10th–90th $309$1,1480%20%10th90th$513$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
$380.19 / $380.19 / $380.19
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$281.84 / $380.19 / $575.44
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$776.25 / $776.25 / $1,258.93
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$660.69 / $724.44 / $851.14
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$398.11 / $1,778.28 / $3,801.89
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$288.40 / $1,096.48 / $1,445.44
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$371.54 / $616.60 / $954.99
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$691.83 / $912.01 / $1,122.02
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$380.19 / $758.58 / $3,311.31
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$338.84 / $457.09 / $851.14
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $70.79 / $436.52
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,230.27 / $1,230.27 / $1,230.27
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$549.54 / $870.96 / $1,513.56
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$776.25 / $1,148.15 / $1,995.26
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$398.11 / $1,548.82 / $3,467.37
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$288.40 / $575.44 / $3,630.78
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$371.54 / $478.63 / $776.25
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$281.84 / $380.19 / $630.96