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Idaho rates for HCPCS L5695

Addition to lower extremity, above knee (AK), pelvic control, sleeve suspension, neoprene or equal, each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.05 / $164.53 / $217.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$122.31 / $122.31 / $163.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.29 / $122.31 / $130.38
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.04 / $154.46 / $235.28
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$176.16 / $185.94 / $195.73
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $144.45 / $172.04
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$171.39 / $191.15 / $286.73
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.01 / $142.88 / $205.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.29 / $97.65 / $151.68