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Idaho rates for HCPCS L5631

Addition to lower extremity, above knee (AK) or knee disarticulation, acrylic socket

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$320.74 / $443.30 / $443.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$329.53 / $329.53 / $330.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$240.56 / $329.53 / $351.29
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.85 / $371.48 / $527.36
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$474.62 / $500.99 / $527.36
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $389.18 / $463.50
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$461.77 / $515.00 / $772.50
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$369.15 / $369.15 / $553.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$243.25 / $263.08 / $408.66