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Alaska rates for HCPCS L5698

Addition to lower extremity, above knee (AK) or knee disarticulation, Silesian bandage

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.41 / $144.41 / $144.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.25 / $99.25 / $99.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.45 / $72.45 / $72.45
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.32 / $40.32 / $40.32
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.57 / $156.68 / $247.40
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.32 / $40.32 / $99.25
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.45 / $111.30 / $175.86
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$82.54 / $94.11 / $94.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.72 / $82.28 / $157.71