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Utah rates for HCPCS L5707

Custom Shaped Protective Cover Hip Disarticulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$478.20 / $478.20 / $478.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.20 / $548.50 / $4,884.62
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 / $1,232.20 / $1,313.59
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$743.57 / $1,199.32 / $1,559.11
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,438.54 / $1,604.35 / $1,604.35
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$913.57 / $1,150.00 / $1,724.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$668.81 / $740.73 / $1,062.67