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Alaska rates for HCPCS L5505

Initial, above knee (AK), knee disarticulation, ischial level socket, nonalignable system, pylon, no cover, SACH foot, plaster socket, direct formed

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,415.46 / $2,415.46 / $2,415.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,620.00 / $1,620.00 / $1,620.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,182.59 / $1,620.00 / $1,668.60
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$672.36 / $672.36 / $672.36
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,983.22 / $2,620.50 / $4,137.63
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$672.36 / $672.36 / $1,620.00
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,182.59 / $1,620.00 / $2,446.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,333.20 / $1,376.14 / $2,637.61