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Alaska rates for HCPCS L5701

Replacement, socket, above knee (AK)/knee disarticulation, including attachment plate, molded to patient model

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,479.42 / $4,479.42 / $4,479.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,550.04 / $2,550.04 / $2,550.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,861.53 / $2,550.04 / $2,990.32
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,314.38 / $1,314.38 / $1,314.38
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,859.64 / $5,059.45 / $7,673.13
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,314.38 / $1,314.38 / $2,550.04
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,861.53 / $2,990.32 / $5,179.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,552.03 / $2,552.03 / $4,891.39