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Maine rates for HCPCS L5707

Custom shaped protective cover, hip disarticulation

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$748.54 / $1,153.84 / $1,153.84
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,523.74 / $1,974.14 / $3,659.44
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$902.90 / $947.48 / $1,286.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,201.05 / $1,232.20 / $1,259.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$899.51 / $899.51 / $1,232.20
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,387.11 / $1,387.11 / $1,387.11
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$964.64 / $1,153.84 / $1,153.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$570.72 / $1,116.05 / $1,965.55