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Idaho rates for HCPCS L6629

Upper extremity addition, quick disconnect lamination collar with coupling piece, Otto Bock or equal

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.99 / $147.87 / $174.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$113.00 / $113.00 / $131.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.49 / $113.00 / $120.47
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.56 / $138.82 / $210.16
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.31 / $167.11 / $175.90
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $129.81 / $154.60
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$154.03 / $171.78 / $257.67
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.13 / $128.41 / $184.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.00 / $87.61 / $136.33