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Virginia rates for HCPCS L5707

Custom shaped protective cover, hip disarticulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$893.32 / $893.32 / $902.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$702.41 / $893.32 / $902.84
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,693.83 / $1,693.83 / $1,798.85
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$902.90 / $902.90 / $1,154.17
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$908.00 / $908.00 / $1,157.89
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 / $1,232.20
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,185.68 / $1,524.45 / $2,032.60
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$478.20 / $1,041.72 / $1,900.48
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$835.00 / $2,224.85 / $2,821.37
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$927.99 / $1,278.31 / $2,021.54
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$927.99 / $1,278.31 / $2,021.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$763.74 / $845.03 / $1,272.90