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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
$13,318.57 / $18,408.09 / $18,408.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,735.03 / $14,513.81 / $14,513.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,595.08 / $10,595.08 / $15,472.44
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,455.32 / $15,425.41 / $21,898.50
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19,708.65 / $20,803.58 / $21,898.50
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19,175.09 / $21,385.25 / $32,077.88
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,328.95 / $15,877.60 / $22,993.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,245.09 / $9,999.21 / $15,858.68