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Alaska rates for HCPCS L5617

Addition to lower extremity, quick change self-aligning unit, above knee (AK) or below knee (BK), each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $398.11 / $588.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $436.52 / $436.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $316.23 / $446.68
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.98 / $588.84 / $645.65
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $645.65 / $1,995.26
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.44 / $645.65 / $676.08
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $645.65 / $660.69
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.98 / $194.98 / $676.08
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $436.52 / $630.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.11 / $398.11 / $457.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $331.13 / $1,479.11