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Alaska rates for HCPCS L5694

Addition to lower extremity, above knee (AK), pelvic control belt, padded and lined

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$301.86 / $301.86 / $301.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.85 / $140.85 / $140.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.82 / $102.82 / $102.82
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.13 / $70.13 / $70.13
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$274.73 / $327.48 / $517.08
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.13 / $70.13 / $140.85
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.82 / $214.48 / $338.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.61 / $171.98 / $329.62