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Idaho rates for HCPCS L8417

Prosthetic sheath/sock, including a gel cushion layer, below knee (BK) or above knee (AK), each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.90 / $74.50 / $74.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.66 / $50.66 / $55.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.97 / $50.66 / $54.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.11 / $62.42 / $88.62
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.76 / $84.19 / $88.62
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $65.40 / $77.89
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.59 / $86.54 / $129.81
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.03 / $64.23 / $93.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.39 / $40.45 / $64.14