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Idaho rates for HCPCS L5701

Replacement, socket, above knee (AK)/knee disarticulation, including attachment plate, molded to patient model

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,215.00 / $4,476.85 / $4,526.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,550.04 / $2,550.04 / $3,412.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,861.53 / $2,550.04 / $2,990.32
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,314.38 / $3,980.47 / $5,325.74
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,793.17 / $5,059.45 / $5,325.74
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $3,930.39 / $4,680.83
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,663.39 / $5,200.92 / $7,801.38
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,728.02 / $3,728.02 / $5,592.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,882.40 / $2,035.96 / $3,558.50