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Idaho rates for HCPCS L5782

Addition to lower limb prosthesis, vacuum pump, residual limb volume management and moisture evacuation system, heavy-duty

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,022.81 / $4,177.93 / $4,177.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,117.33 / $3,294.10 / $3,294.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,404.69 / $3,294.10 / $3,511.67
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,465.11 / $3,500.97 / $4,970.12
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,473.10 / $4,721.60 / $4,970.12
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $3,667.95 / $4,368.27
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,352.01 / $4,853.63 / $7,280.45
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,479.08 / $3,603.63 / $5,218.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,098.29 / $2,269.44 / $3,599.32