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Idaho rates for HCPCS L5677

Additions to lower extremity, below knee (BK), knee joints, polycentric, pair

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$392.27 / $542.17 / $656.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$400.78 / $400.78 / $494.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.57 / $400.78 / $427.25
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.60 / $484.71 / $644.98
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$580.48 / $612.73 / $644.98
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $475.99 / $566.87
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$564.77 / $629.86 / $944.79
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$451.49 / $451.49 / $677.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$272.97 / $295.24 / $468.24