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Idaho rates for HCPCS L5642

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $602.56 / $831.76
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.95 / $933.25 / $1,445.44
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,122.02 / $1,122.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$467.74 / $524.81 / $524.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.05 / $389.05 / $524.81
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.88 / $758.58 / $1,000.00
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $954.99 / $1,000.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $851.14
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$933.25 / $977.24 / $977.24
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $707.95 / $1,122.02
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,000.00 / $1,000.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$275.42 / $489.78 / $562.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $371.54 / $575.44