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Vermont rates for HCPCS L5707

Custom shaped protective cover, hip disarticulation

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $891.25 / $1,023.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,230.27 / $1,230.27 / $1,258.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $891.25 / $1,230.27
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $1,584.89 / $1,995.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$851.14 / $977.24 / $1,174.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $1,288.25 / $3,548.13