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Missouri rates for HCPCS L5707

Custom shaped protective cover, hip disarticulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$788.56 / $1,166.42 / $1,203.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$788.56 / $903.56 / $1,642.84
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,726.00 / $1,812.30 / $7,967.22
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.75 / $902.90 / $1,396.41
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
$899.51 / $899.51 / $1,313.59
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$788.56 / $1,391.01 / $7,733.84
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$617.28 / $922.60 / $1,583.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$617.28 / $861.08 / $1,222.27