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Alaska rates for HCPCS L5658

Addition to lower extremity, socket insert, above knee (AK) (Kemblo, Pelite, Aliplast, Plastazote or equal)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$379.66 / $379.66 / $379.66
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$366.26 / $366.26 / $366.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$267.37 / $366.26 / $390.45
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.55 / $140.55 / $140.55
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$411.88 / $552.78 / $650.34
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.55 / $140.55 / $366.26
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$267.37 / $390.45 / $521.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$216.30 / $216.30 / $414.58