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Idaho rates for HCPCS L5685

Addition to lower extremity prosthesis, below knee, suspension/sealing sleeve, with or without valve, any material, each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.79 / $126.86 / $126.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$94.65 / $100.03 / $100.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.02 / $100.03 / $106.64
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.49 / $106.31 / $150.91
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$135.83 / $143.37 / $150.91
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $111.38 / $132.63
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$132.15 / $147.38 / $221.07
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.64 / $109.43 / $158.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.71 / $68.92 / $109.29