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Idaho rates for HCPCS L5595

Preparatory, hip disarticulation/hemipelvectomy, pylon, no cover, SACH foot, thermoplastic or equal, molded to patient model

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,295.29 / $4,554.54 / $5,360.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,578.08 / $3,578.08 / $4,041.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,612.00 / $2,612.00 / $5,074.41
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,556.51 / $4,071.77 / $5,418.13
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,876.32 / $5,147.22 / $5,418.13
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $3,998.58 / $4,762.03
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,744.31 / $5,291.14 / $7,936.71
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,792.69 / $3,792.69 / $5,689.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,229.17 / $2,411.02 / $3,823.86