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Alaska rates for HCPCS L5631

Addition to lower extremity, above knee (AK) or knee disarticulation, acrylic socket

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $398.11 / $467.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$331.13 / $331.13 / $331.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.88 / $239.88 / $354.81
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.82 / $457.09 / $501.19
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $512.86 / $1,621.81
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.09 / $512.86 / $537.03
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $512.86 / $524.81
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.82 / $169.82 / $537.03
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $331.13 / $501.19
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$346.74 / $346.74 / $398.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $263.03 / $1,258.93