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Alaska rates for HCPCS L5677

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$871.37 / $871.37 / $871.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$400.78 / $400.78 / $400.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.57 / $400.78 / $427.25
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.60 / $190.60 / $190.60
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$612.73 / $945.34 / $1,492.64
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.60 / $190.60 / $400.78
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.57 / $427.25 / $751.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$480.95 / $496.44 / $951.51