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Alaska rates for HCPCS L5649

Addition to lower extremity, ischial containment/narrow M-L socket

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,038.22 / $2,038.22 / $2,038.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,800.00 / $1,800.00 / $1,800.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,314.00 / $1,800.00 / $2,110.78
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$736.00 / $736.00 / $736.00
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,211.23 / $2,294.77 / $3,491.42
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$736.00 / $736.00 / $1,800.00
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,314.00 / $1,800.00 / $2,727.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,124.99 / $1,161.22 / $2,225.67