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Alaska rates for HCPCS L5668

Addition to lower extremity, below knee (BK), molded distal cushion

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $91.20 / $147.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.13 / $89.13 / $89.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $64.57 / $95.50
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.90 / $123.03 / $165.96
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $165.96 / $407.38
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.49 / $165.96 / $173.78
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $165.96 / $169.82
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.90 / $38.90 / $165.96
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $89.13 / $128.82
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.43 / $79.43 / $91.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.18 / $85.11 / $295.12