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Idaho rates for HCPCS L5105

Below knee (BK), plastic socket, joints and thigh lacer, SACH foot

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,041.74 / $2,884.03 / $3,981.07
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,388.44 / $4,466.84 / $6,918.31
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,011.87 / $5,370.32 / $5,370.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,019.95 / $3,019.95 / $3,467.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,187.76 / $2,187.76 / $3,019.95
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,348.96 / $3,981.07 / $5,128.61
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,981.07 / $4,570.88 / $4,786.30
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $4,073.80
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,466.84 / $4,570.88 / $4,570.88
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,388.44 / $3,388.44 / $5,370.32
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,801.89 / $4,786.30 / $4,786.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,570.40 / $2,754.23 / $3,162.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,905.46 / $2,089.30 / $3,162.28