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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
$93.33 / $114.82 / $190.55
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$141.25 / $169.82 / $281.84
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $199.53 / $199.53
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.20 / $112.20 / $131.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.18 / $83.18 / $112.20
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $147.91 / $218.78
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $169.82 / $177.83
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $151.36
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.96 / $169.82 / $169.82
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $151.36 / $199.53
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $177.83 / $223.87
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.86 / $114.82 / $131.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $87.10 / $134.90