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Idaho rates for HCPCS L5679

Addition To Lower Extremity Below Knee/Above Kneecustom Fabricated Fromexisting Mold Or Prefabric Ated Socket Insert Silicone Gel Elastomeric Or Equal Not For Use With Locking Mechanism

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$435.74 / $602.25 / $651.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$440.05 / $440.05 / $491.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$321.24 / $440.05 / $516.02
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$215.25 / $538.41 / $757.79
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$644.79 / $680.62 / $716.44
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $528.73 / $629.69
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$627.34 / $699.65 / $1,049.48
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.51 / $523.00 / $752.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$308.27 / $333.42 / $528.80