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Alaska rates for HCPCS L5697

Addition to lower extremity, above knee (AK) or knee disarticulation, pelvic band

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.23 / $127.23 / $127.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.21 / $60.21 / $60.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.95 / $60.21 / $64.19
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.03 / $31.03 / $31.03
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.05 / $138.04 / $217.95
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.03 / $31.03 / $60.21
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.95 / $64.19 / $122.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.22 / $72.48 / $138.93