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Idaho rates for HCPCS L5668

Addition to lower extremity, below knee (BK), molded distal cushion

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $81.28 / $114.82
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.15 / $128.82 / $218.78
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $151.36 / $151.36
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.13 / $89.13 / $102.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $64.57 / $89.13
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.90 / $112.20 / $165.96
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.15 / $131.83 / $138.04
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $117.49
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.82 / $131.83 / $131.83
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $95.50 / $151.36
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.15 / $138.04 / $138.04
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.43 / $81.28 / $91.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $60.26 / $93.33