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Idaho rates for HCPCS L5696

Addition to lower extremity, above knee (AK) or knee disarticulation, pelvic joint

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.57 / $248.90 / $248.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.76 / $138.76 / $185.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.29 / $138.76 / $147.91
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.52 / $208.57 / $296.08
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$266.48 / $281.29 / $296.08
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $218.51 / $260.24
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$259.27 / $289.14 / $433.73
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$207.26 / $207.26 / $310.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.43 / $110.79 / $229.45