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Arizona rates for HCPCS L5654

Addition to lower extremity, socket insert, Symes, (Kemblo, Pelite, Aliplast, Plastazote or equal)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$178.07 / $220.07 / $302.19
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.38 / $463.82 / $838.56
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$320.98 / $427.98 / $583.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$306.16 / $306.16 / $306.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.50 / $223.50 / $548.63
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.19 / $326.77 / $2,089.06
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$179.48 / $198.59 / $306.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$179.48 / $198.59 / $303.88