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Idaho rates for HCPCS L5857

Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing phase only, includes electronic sensor(s), any type

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,466.84 / $6,165.95 / $8,709.64
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,079.46 / $9,549.93 / $14,791.08
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,715.19 / $11,220.18 / $11,220.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,309.57 / $6,606.93 / $6,606.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,897.79 / $4,897.79 / $6,606.93
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,951.21 / $8,511.38 / $11,220.18
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,317.64 / $9,772.37 / $10,232.93
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,549.93 / $9,772.37 / $9,772.37
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,244.36 / $7,413.10 / $11,220.18
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,943.28 / $10,232.93 / $10,471.29
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,025.60 / $6,918.31 / $6,918.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,265.80 / $4,570.88 / $7,079.46