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Alaska rates for HCPCS L5692

Addition to lower extremity, above knee (AK), pelvic control belt, light

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $120.23 / $234.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $72.44 / $107.15
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.29 / $169.82 / $263.03
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $263.03 / $575.44
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.18 / $263.03 / $275.42
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $263.03 / $269.15
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.29 / $51.29 / $218.78
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $100.00 / $177.83
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.71 / $104.71 / $120.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $134.90 / $389.05