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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
$12,022.64 / $13,182.57 / $19,054.61
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,454.40 / $14,454.40 / $14,454.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,715.19 / $10,715.19 / $15,488.17
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,456.54 / $19,054.61 / $21,379.62
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,218.10 / $22,387.21 / $72,443.60
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19,054.61 / $21,379.62 / $22,387.21
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17,378.01 / $21,379.62 / $21,877.62
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,456.54 / $6,456.54 / $22,387.21
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $14,454.40 / $20,892.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,182.57 / $13,182.57 / $15,135.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,964.78 / $10,964.78 / $47,863.01