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Idaho rates for HCPCS L5654

Addition to lower extremity, socket insert, Symes, (Kemblo, Pelite, Aliplast, Plastazote or equal)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$282.82 / $390.89 / $406.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$306.16 / $306.16 / $306.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.50 / $306.16 / $326.39
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.19 / $349.10 / $465.01
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$418.51 / $441.76 / $465.01
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $343.17 / $408.70
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$407.18 / $454.11 / $681.17
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$325.51 / $325.51 / $488.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$183.61 / $198.59 / $314.95