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Alaska rates for HCPCS L5971

All lower extremity prostheses, solid ankle cushion heel (SACH) foot, replacement only

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $177.83 / $281.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$158.49 / $158.49 / $158.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.49 / $117.49 / $169.82
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.62 / $309.03 / $309.03
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $309.03 / $891.25
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$257.04 / $309.03 / $323.59
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $309.03 / $316.23
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.62 / $77.62 / $309.03
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $158.49 / $281.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.18 / $162.18 / $181.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $158.49 / $588.84