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Idaho rates for HCPCS L5976

All lower extremity prostheses, energy storing foot (Seattle Carbon Copy II or equal)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$456.99 / $631.63 / $745.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$420.01 / $420.01 / $562.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$306.61 / $420.01 / $447.75
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$216.49 / $564.67 / $751.39
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.25 / $713.82 / $751.39
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $554.52 / $660.40
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$657.95 / $733.78 / $1,100.67
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$525.97 / $525.97 / $788.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$310.04 / $335.33 / $531.84