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Alaska rates for HCPCS L5639

Addition To Lower Extremity Below Knee Wood Socket

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,012.85 / $2,012.85 / $2,012.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$870.50 / $870.50 / $870.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$635.47 / $870.50 / $896.62
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$433.41 / $433.41 / $433.41
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,440.87 / $2,183.69 / $3,447.95
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$433.41 / $433.41 / $870.50
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$635.47 / $870.50 / $1,707.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,110.98 / $1,146.77 / $2,197.96