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Idaho rates for HCPCS L5697

Addition To Lower Extremity Above Knee Or Knee Disarticulation Pelvic Band

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.39 / $107.99 / $107.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.21 / $60.21 / $80.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.95 / $60.21 / $64.19
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.03 / $90.50 / $128.47
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.62 / $122.05 / $128.47
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $94.80 / $112.91
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.49 / $125.46 / $188.19
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.93 / $89.93 / $134.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.44 / $48.07 / $99.55