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Idaho rates for HCPCS L5699

All Lower Extremity Prostheses Shoulder Harness

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.82 / $248.02 / $248.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.96 / $169.96 / $187.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.07 / $124.07 / $234.98
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.08 / $207.95 / $295.05
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$265.55 / $280.30 / $295.05
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $217.75 / $259.32
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$258.35 / $288.13 / $432.20
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$206.54 / $206.54 / $309.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.22 / $111.65 / $228.63