go back

Alaska rates for HCPCS L5857

Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing phase only, includes electronic sensor(s), any type

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,495.41 / $6,165.95 / $8,912.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,606.93 / $6,606.93 / $6,606.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,897.79 / $4,897.79 / $6,918.31
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,951.21 / $8,511.38 / $9,772.37
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,772.37 / $9,772.37 / $30,902.95
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,709.64 / $9,772.37 / $10,232.93
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,943.28 / $9,772.37 / $10,000.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,951.21 / $2,951.21 / $10,232.93
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $6,606.93 / $9,549.93
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,025.60 / $6,025.60 / $6,918.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,897.79 / $5,011.87 / $22,387.21