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Arizona rates for HCPCS L2628

Addition to lower extremity, pelvic control, metal frame, reciprocating hip joint and cables

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$754.99 / $1,125.02 / $1,990.34
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$495.53 / $1,790.09 / $3,236.42
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,238.83 / $1,651.77 / $2,250.53
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,179.41 / $1,179.41 / $1,179.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$860.97 / $860.97 / $2,188.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$607.91 / $1,315.39 / $10,013.70
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$850.22 / $941.64 / $1,418.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.07 / $941.64 / $1,418.45