go back

Montana rates for HCPCS L5707

Custom shaped protective cover, hip disarticulation

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,408.30 / $4,884.62 / $4,884.62
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,232.20 / $1,724.99 / $1,724.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,232.20 / $1,402.78 / $1,724.99
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$827.78 / $1,642.85 / $1,724.99
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,232.20 / $1,294.69 / $1,726.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$669.48 / $740.73 / $1,141.43