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Idaho rates for HCPCS L6026

Transcarpal/metacarpal or partial hand disarticulation prosthesis, external power, self-suspended, inner socket with removable forearm section, electrodes and cables, two batteries, charger, myoelectric control of terminal device, excludes terminal device(s)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,187.88 / $4,406.08 / $4,627.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,323.97 / $3,323.97 / $3,323.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,426.50 / $3,323.97 / $3,423.69
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,295.85 / $4,406.08 / $5,562.49
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,717.38 / $4,979.45 / $5,241.53
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
$4,589.67 / $5,118.68 / $7,678.02
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,669.07 / $3,826.32 / $5,503.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,144.89 / $2,244.96 / $3,574.81