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Alaska rates for HCPCS L5665

Addition to lower extremity, socket insert, multidurometer, below knee (BK)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $371.54 / $851.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.09 / $457.09 / $457.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $331.13 / $478.63
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$199.53 / $630.96 / $933.25
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $933.25 / $1,862.09
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$537.03 / $933.25 / $977.24
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $933.25 / $954.99
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$199.53 / $199.53 / $851.14
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $457.09 / $588.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$407.38 / $407.38 / $457.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $478.63 / $1,479.11