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Alaska rates for HCPCS L5672

Addition to lower extremity, below knee (BK), removable medial brim suspension

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.17 / $234.42 / $363.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$295.12 / $295.12 / $295.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.78 / $218.78 / $309.03
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$114.82 / $316.23 / $354.81
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $371.54 / $1,174.90
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$338.84 / $354.81 / $371.54
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $354.81 / $363.08
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$114.82 / $114.82 / $407.38
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $288.40 / $371.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$234.42 / $234.42 / $269.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $181.97 / $870.96