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Idaho rates for HCPCS L5658

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$353.89 / $489.13 / $489.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$283.37 / $366.26 / $366.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$267.37 / $366.26 / $390.45
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.55 / $409.88 / $581.87
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$523.67 / $552.78 / $581.87
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $429.41 / $511.41
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$509.51 / $568.23 / $852.35
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.31 / $407.31 / $610.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$201.30 / $217.72 / $388.79