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Alaska rates for HCPCS L5210

Above knee (AK), short prosthesis, no knee joint (stubbies), with foot blocks, no ankle joints, each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,273.23 / $3,273.23 / $3,273.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,819.89 / $1,819.89 / $1,819.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,328.52 / $1,819.89 / $1,940.10
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$938.03 / $938.03 / $938.03
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,551.07 / $3,689.14 / $5,606.96
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$938.03 / $938.03 / $1,819.89
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,328.52 / $1,940.10 / $3,696.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,864.83 / $1,864.83 / $3,574.26