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Idaho rates for HCPCS L5694

Addition To Lower Extremity Above Knee Pelvic Control Belt Padded And Lined

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.88 / $243.09 / $243.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.85 / $140.85 / $182.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.82 / $102.82 / $254.88
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.13 / $212.55 / $289.19
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$260.27 / $274.73 / $289.19
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $213.42 / $254.17
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$253.22 / $282.41 / $423.62
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$202.43 / $202.43 / $303.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.43 / $108.63 / $362.14