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Idaho rates for HCPCS L5781

Addition To Lower Limb Prosthesis Vacuum Pump Residual Limb Volume Management And Moisture Evacuation System

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,867.32 / $3,963.03 / $3,963.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,886.72 / $2,886.72 / $2,956.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,107.31 / $2,886.72 / $3,077.39
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,389.75 / $3,320.89 / $4,714.47
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,243.03 / $4,478.76 / $4,714.47
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $3,479.28 / $4,143.58
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,128.16 / $4,603.97 / $6,905.97
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,300.14 / $3,418.28 / $4,950.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,990.36 / $2,152.71 / $3,414.19