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Alaska rates for HCPCS L4205

Repair of orthotic device, labor component, per 15 minutes

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.02 / $18.20 / $21.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.39 / $22.39 / $22.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.22 / $16.22 / $23.44
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.02 / $26.92 / $40.74
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.18 / $42.66 / $138.04
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.11 / $42.66 / $114.82
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.86 / $114.82 / $131.83
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.02 / $12.02 / $38.02
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.22 / $23.44 / $60.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.80 / $13.80 / $14.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.60 / $30.90 / $102.33