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Alaska rates for HCPCS L5629

Addition to lower extremity, below knee, acrylic socket

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$255.20 / $255.20 / $255.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$248.05 / $248.05 / $248.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.08 / $248.05 / $264.43
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$122.85 / $122.85 / $122.85
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$276.86 / $362.36 / $437.15
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$122.85 / $122.85 / $248.05
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.08 / $248.05 / $341.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.86 / $145.40 / $278.68