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Arizona rates for HCPCS L5642

Addition to lower extremity, above knee (AK), leather socket

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $407.38 / $1,479.11
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.98 / $446.68 / $933.25
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $741.31 / $1,412.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$524.81 / $524.81 / $524.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.05 / $389.05 / $524.81
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.88 / $524.81 / $3,890.45
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.84 / $371.54 / $4,897.79
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.40 / $575.44 / $588.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.84 / $371.54 / $562.34