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Alaska rates for HCPCS L5250

Hip disarticulation, Canadian type; molded socket, hip joint, single axis constant friction knee, shin, SACH foot

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,715.35 / $4,677.35 / $9,120.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,365.16 / $4,365.16 / $4,365.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,162.28 / $3,162.28 / $4,466.84
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $7,244.36 / $10,000.00
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,413.10 / $10,000.00 / $23,442.29
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,760.83 / $10,232.93 / $10,715.19
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,317.64 / $10,232.93 / $10,471.29
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $1,995.26 / $8,511.38
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $4,365.16 / $7,244.36
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,073.80 / $4,073.80 / $4,677.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,677.35 / $5,128.61 / $15,135.61