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Idaho rates for HCPCS L5655

Addition to lower extremity, socket insert, below knee (BK) (Kemblo, Pelite, Aliplast, Plastazote or equal)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$231.62 / $350.25 / $353.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$221.07 / $221.07 / $266.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.38 / $221.07 / $235.67
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.53 / $295.82 / $416.66
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$374.99 / $395.83 / $416.66
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $307.49 / $366.20
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$364.84 / $406.89 / $610.34
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$291.66 / $291.66 / $437.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$146.84 / $158.83 / $278.39