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Alaska rates for HCPCS L5643

Addition to lower extremity, hip disarticulation, flexible inner socket, external frame

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,627.00 / $1,627.00 / $1,627.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,167.30 / $1,167.30 / $1,167.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$852.13 / $1,167.30 / $1,244.40
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$601.66 / $601.66 / $601.66
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,765.11 / $2,037.32 / $2,787.02
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$601.66 / $601.66 / $1,167.30
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$852.13 / $1,244.40 / $2,177.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$898.02 / $926.94 / $1,776.64