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Alaska rates for HCPCS L5626

Addition to lower extremity, test socket, hip disarticulation

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.12 / $575.12 / $575.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$493.58 / $493.58 / $493.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$360.31 / $493.58 / $526.19
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$184.31 / $184.31 / $184.31
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$623.51 / $623.92 / $985.16
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$184.31 / $184.31 / $493.58
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$360.31 / $493.58 / $726.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$317.44 / $327.66 / $628.02