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Illinois rates for HCPCS L5707

Custom Shaped Protective Cover Hip Disarticulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$897.80 / $897.80 / $897.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$702.41 / $897.80 / $1,347.13
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,167.17 / $3,666.47 / $15,607.50
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,378.59 / $1,378.59 / $1,378.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,232.20 / $1,232.20 / $1,898.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$899.51 / $1,232.20 / $2,103.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,470.45 / $1,813.93 / $2,278.06
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,358.11 / $2,358.11 / $2,358.11
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,024.02 / $1,462.89 / $1,536.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$669.18 / $904.95 / $1,588.97