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Arizona rates for HCPCS L5622

Addition to lower extremity, test socket, knee disarticulation

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.65 / $204.75 / $326.31
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$341.24 / $341.24 / $341.24
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$119.45 / $431.51 / $780.14
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$298.63 / $398.17 / $542.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$274.54 / $274.54 / $274.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$200.41 / $200.41 / $559.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.13 / $317.08 / $2,359.33
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$196.19 / $217.07 / $334.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$196.19 / $217.07 / $326.99