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Arizona rates for HCPCS L5628

Addition To Lower Extremity Test Socket Hemipelvectomy

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$261.08 / $273.73 / $471.57
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$152.32 / $550.26 / $994.84
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.80 / $507.74 / $691.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$499.82 / $499.82 / $499.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$364.87 / $364.87 / $895.88
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.64 / $404.34 / $3,076.44
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$261.30 / $289.10 / $445.50
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.46 / $382.03 / $435.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$261.30 / $289.10 / $435.50