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Alaska rates for HCPCS L5220

Above knee (AK), short prosthesis, no knee joint (stubbies), with articulated ankle/foot, dynamically aligned, each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,490.78 / $4,490.78 / $4,490.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,482.86 / $2,482.86 / $2,482.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,812.49 / $2,482.86 / $2,646.85
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,066.25 / $1,066.25 / $1,066.25
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,193.39 / $4,871.97 / $7,692.59
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,066.25 / $1,066.25 / $2,482.86
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,812.49 / $2,646.85 / $4,201.39
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,182.50 / $2,488.46 / $2,488.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,527.40 / $2,558.50 / $4,903.78