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Alaska rates for HCPCS L5637

Addition to lower extremity, below knee (BK), total contact

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.93 / $263.03 / $389.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$234.42 / $234.42 / $234.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $169.82 / $275.42
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.20 / $354.81 / $436.52
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $436.52 / $1,096.48
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$316.23 / $436.52 / $457.09
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $436.52 / $446.68
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.20 / $112.20 / $467.74
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $234.42 / $338.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$229.09 / $229.09 / $263.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.78 / $223.87 / $831.76