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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
$149.66 / $149.66 / $149.66
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.19 / $89.19 / $89.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.11 / $89.19 / $95.08
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.04 / $39.04 / $39.04
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.94 / $162.37 / $256.38
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.04 / $39.04 / $89.19
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.11 / $95.08 / $153.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.61 / $85.27 / $163.44