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Alaska rates for HCPCS L5500

Initial, below knee (BK) PTB type socket, nonalignable system, pylon, no cover, SACH foot, plaster socket, direct formed

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,803.66 / $1,803.66 / $1,803.66
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$963.22 / $963.22 / $963.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$703.15 / $963.22 / $992.12
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$496.48 / $496.48 / $496.48
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,464.43 / $1,956.76 / $3,089.63
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$496.48 / $496.48 / $963.22
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$703.15 / $992.12 / $1,806.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,027.58 / $1,027.58 / $1,969.54