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Arizona rates for HCPCS L5629

Addition to lower extremity, below knee, acrylic socket

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.63 / $171.64 / $283.89
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$286.07 / $286.07 / $293.70
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.14 / $361.77 / $654.07
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$271.20 / $333.80 / $429.77
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$248.05 / $248.05 / $248.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.08 / $181.08 / $442.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$122.85 / $254.87 / $2,003.74
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$171.99 / $190.30 / $293.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$171.99 / $190.30 / $286.64