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Idaho rates for HCPCS L5613

Addition to lower extremity, endoskeletal system, above knee (AK), knee disarticulation, four-bar linkage, with hydraulic swing phase control

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,788.97 / $2,472.60 / $3,262.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,902.78 / $1,902.78 / $2,459.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,389.03 / $1,902.78 / $1,959.86
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$947.36 / $2,321.03 / $3,535.82
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,647.29 / $2,794.36 / $2,941.43
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $2,170.77 / $2,585.23
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,575.62 / $2,872.49 / $4,308.74
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,059.00 / $2,147.23 / $3,088.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,356.77 / $1,467.45 / $2,279.38