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Arizona rates for HCPCS L5626

Addition to lower extremity, test socket, hip disarticulation

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $346.74 / $1,380.38
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.78 / $398.11 / $831.76
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $660.69 / $1,258.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $489.78 / $489.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $363.08 / $489.78
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.21 / $436.52 / $3,090.30
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $288.40 / $3,388.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.00 / $436.52 / $524.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $288.40 / $426.58