go back

Idaho rates for HCPCS L5628

Addition To Lower Extremity Test Socket Hemipelvectomy

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$421.61 / $609.99 / $609.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$363.91 / $499.82 / $499.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$364.87 / $499.82 / $514.80
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.64 / $511.16 / $725.66
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$653.09 / $689.38 / $725.66
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $535.53 / $637.79
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$635.41 / $708.65 / $1,062.98
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$507.96 / $507.96 / $761.94
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.46 / $0.46 / $433.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$267.30 / $289.10 / $484.88