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Alaska rates for HCPCS L5700

Replacement, socket, below knee (BK), molded to patient model

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,949.84 / $2,691.53 / $3,715.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,398.83 / $2,398.83 / $2,398.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $1,737.80 / $2,818.38
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $3,311.31 / $3,630.78
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,630.78 / $4,265.80 / $12,302.69
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,715.35 / $3,715.35 / $3,890.45
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,019.95 / $3,715.35 / $3,801.89
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $1,047.13 / $4,466.84
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $2,398.83 / $4,168.69
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,187.76 / $2,187.76 / $2,454.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $1,905.46 / $7,943.28