go back

Idaho rates for HCPCS L5505

Initial, above knee (AK), knee disarticulation, ischial level socket, nonalignable system, pylon, no cover, SACH foot, plaster socket, direct formed

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,269.67 / $1,754.85 / $2,315.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,620.00 / $1,620.00 / $1,745.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,182.59 / $1,620.00 / $1,668.60
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$672.36 / $1,635.47 / $2,363.76
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,878.84 / $1,983.22 / $2,087.60
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $1,540.64 / $1,834.80
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,827.97 / $2,038.67 / $3,058.01
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,461.32 / $1,523.95 / $2,191.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$962.93 / $1,041.48 / $1,617.73