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Alaska rates for HCPCS L5628

Addition To Lower Extremity Test Socket Hemipelvectomy

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$486.79 / $486.79 / $486.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$499.82 / $499.82 / $499.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$364.87 / $499.82 / $514.80
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.64 / $186.64 / $186.64
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$528.11 / $689.38 / $833.87
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.64 / $186.64 / $499.82
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$364.87 / $514.80 / $690.69
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$382.03 / $435.59 / $435.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$268.69 / $277.33 / $531.55