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Alaska rates for HCPCS L5676

Additions to lower extremity, below knee (BK), knee joints, single axis, pair

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $323.59 / $524.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$269.15 / $269.15 / $269.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.53 / $199.53 / $288.40
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$141.25 / $501.19 / $588.84
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $588.84 / $1,548.82
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $588.84 / $616.60
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $588.84 / $602.56
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$141.25 / $141.25 / $588.84
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $269.15 / $478.63
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.40 / $288.40 / $323.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $302.00 / $1,047.13