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Alaska rates for HCPCS L5858

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19,175.84 / $19,175.84 / $19,175.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,513.81 / $14,513.81 / $14,513.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,595.08 / $14,513.81 / $15,472.44
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,455.32 / $6,455.32 / $6,455.32
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20,803.58 / $20,803.58 / $32,847.75
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,455.32 / $6,455.32 / $14,513.81
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,595.08 / $15,472.44 / $25,662.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,924.91 / $10,924.91 / $20,939.41