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Idaho rates for HCPCS L5971

All lower extremity prostheses, solid ankle cushion heel (SACH) foot, replacement only

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$179.05 / $247.48 / $255.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$159.21 / $159.21 / $192.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.22 / $116.22 / $169.72
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$78.51 / $213.71 / $294.41
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$264.97 / $279.69 / $294.41
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $217.27 / $258.76
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$257.79 / $287.51 / $431.27
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$206.09 / $206.09 / $309.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.44 / $121.61 / $196.72