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Idaho rates for HCPCS L5614

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,209.27 / $1,671.38 / $1,671.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,247.08 / $1,317.79 / $1,317.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$961.99 / $1,317.79 / $1,357.32
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$586.11 / $1,400.56 / $1,988.29
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,789.46 / $1,888.88 / $1,988.29
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $1,467.35 / $1,747.52
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,741.02 / $1,941.69 / $2,912.54
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,391.80 / $1,441.64 / $2,087.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$839.41 / $907.89 / $1,439.90