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Alaska rates for HCPCS L5781

Addition To Lower Limb Prosthesis Vacuum Pump Residual Limb Volume Management And Moisture Evacuation System

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,128.33 / $4,128.33 / $4,128.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,886.72 / $2,886.72 / $2,886.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,107.31 / $2,886.72 / $3,077.39
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,389.75 / $1,389.75 / $1,389.75
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,478.76 / $4,478.76 / $7,071.72
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,389.75 / $1,389.75 / $2,886.72
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,107.31 / $3,077.39 / $4,647.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,278.61 / $2,352.00 / $4,508.00