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Idaho rates for HCPCS L5697

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.77 / $77.62 / $107.15
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.33 / $123.03 / $186.21
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $144.54 / $144.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.26 / $60.26 / $81.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.65 / $43.65 / $60.26
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.90 / $95.50 / $131.83
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.15 / $125.89 / $131.83
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $112.20
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$123.03 / $125.89 / $125.89
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $91.20 / $144.54
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $131.83 / $131.83
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.10 / $67.61 / $72.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $47.86 / $74.13