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Idaho rates for HCPCS L5220

Above knee (AK), short prosthesis, no knee joint (stubbies), with articulated ankle/foot, dynamically aligned, each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,631.71 / $3,710.52 / $3,710.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,482.86 / $2,482.86 / $2,768.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,812.49 / $2,482.86 / $2,646.85
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,066.25 / $3,109.31 / $4,414.09
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,972.68 / $4,193.39 / $4,414.09
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $3,257.59 / $3,879.57
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,865.13 / $4,310.63 / $6,465.95
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,089.86 / $3,089.86 / $4,634.79
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.64 / $2,477.41 / $2,545.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,527.05 / $1,651.61 / $2,619.44