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Michigan rates for HCPCS L5707

Custom shaped protective cover, hip disarticulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,035.92 / $1,035.92 / $1,035.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$830.58 / $1,035.92 / $1,035.92
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,745.49 / $5,470.09 / $9,962.83
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,723.23 / $1,813.93 / $2,448.81
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$965.62 / $1,100.99 / $1,179.05
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,451.14 / $1,451.14 / $1,451.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,232.20 / $1,232.20 / $1,232.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,232.20 / $1,232.20 / $2,103.00
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,035.92 / $1,310.81 / $1,310.81
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$923.70 / $1,310.81 / $1,904.62
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,100.69 / $1,342.31 / $1,543.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$617.28 / $902.93 / $1,298.25