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South Carolina rates for HCPCS L5707

Custom shaped protective cover, hip disarticulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $660.69 / $660.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $831.76 / $1,148.15
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,513.56 / $1,737.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $1,230.27 / $2,630.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $891.25 / $2,041.74
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $1,023.29 / $1,122.02
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $1,174.90 / $2,570.40
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $478.63 / $478.63
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $1,000.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$851.14 / $1,122.02 / $2,041.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $741.31 / $1,122.02