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New Hampshire rates for HCPCS L5707

Custom shaped protective cover, hip disarticulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$964.64 / $964.64 / $1,157.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$748.54 / $756.42 / $964.64
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,713.22 / $1,713.22 / $2,030.85
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$902.90 / $902.90 / $947.48
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 / $1,259.18
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,387.11 / $1,387.11 / $4,281.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$569.79 / $854.71 / $1,141.43
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,283.14 / $1,411.45 / $1,796.40