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Idaho rates for HCPCS L5624

Addition to lower extremity, test socket, above knee (AK)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$274.94 / $380.01 / $415.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$311.77 / $311.77 / $313.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$227.60 / $311.77 / $332.37
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.54 / $339.73 / $452.07
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$406.86 / $429.47 / $452.07
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $333.62 / $397.32
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$395.84 / $441.47 / $662.21
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.45 / $316.45 / $474.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$201.28 / $217.69 / $344.68