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Idaho rates for HCPCS L5858

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,772.37 / $13,182.57 / $18,620.87
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15,488.17 / $20,892.96 / $32,359.37
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23,442.29 / $24,547.09 / $24,547.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,803.84 / $14,454.40 / $14,454.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,715.19 / $10,715.19 / $14,454.40
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,456.54 / $21,379.62 / $22,908.68
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18,197.01 / $21,379.62 / $22,387.21
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
$20,892.96 / $21,379.62 / $21,379.62
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,488.17 / $16,218.10 / $24,547.09
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17,378.01 / $22,387.21 / $22,908.68
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,182.57 / $15,135.61 / $15,135.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,332.54 / $10,000.00 / $15,488.17