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Alaska rates for HCPCS L5624

Addition to lower extremity, test socket, above knee (AK)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$449.48 / $449.48 / $449.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$311.77 / $311.77 / $311.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$227.60 / $311.77 / $332.37
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.54 / $140.54 / $140.54
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$429.47 / $487.64 / $769.95
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.54 / $140.54 / $311.77
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$227.60 / $332.37 / $475.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$256.08 / $256.08 / $490.83