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Alaska rates for HCPCS L5647

Addition to lower extremity, below knee (BK), suction socket

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $575.44 / $1,288.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$602.56 / $602.56 / $602.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $436.52 / $630.96
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$309.03 / $933.25 / $1,412.54
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,412.54 / $2,951.21
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.76 / $1,412.54 / $1,479.11
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $1,412.54 / $1,445.44
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$309.03 / $309.03 / $1,288.25
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $602.56 / $912.01
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $630.96 / $724.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $724.44 / $2,290.87