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West Virginia rates for HCPCS L5707

Custom shaped protective cover, hip disarticulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$830.58 / $830.58 / $830.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$830.58 / $830.58 / $893.32
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,100.99 / $2,117.29 / $2,964.20
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,039.90 / $1,185.68 / $1,782.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,232.20 / $1,232.20 / $1,900.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$899.51 / $1,232.20 / $7,965.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$836.01 / $1,034.73 / $1,408.38