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Alaska rates for HCPCS L5642

Addition to lower extremity, above knee (AK), leather socket

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$523.83 / $523.83 / $523.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$530.41 / $530.41 / $530.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$387.20 / $387.20 / $387.20
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.50 / $239.50 / $239.50
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$568.29 / $897.30 / $941.93
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.50 / $239.50 / $530.41
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$387.20 / $707.80 / $1,161.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$298.44 / $298.44 / $572.01