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Alaska rates for HCPCS L5540

Preparatory, below knee (BK) PTB type socket, nonalignable system, pylon, no cover, SACH foot, laminated socket, molded to model

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,511.07 / $2,511.07 / $2,511.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,599.98 / $1,599.98 / $1,599.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,167.99 / $1,599.98 / $1,705.66
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$699.67 / $699.67 / $699.67
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,522.81 / $2,724.21 / $4,301.39
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$699.67 / $699.67 / $1,599.98
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,167.99 / $1,705.66 / $2,755.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,385.97 / $1,430.61 / $2,742.00