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Arizona rates for HCPCS L5655

Addition to lower extremity, socket insert, below knee (BK) (Kemblo, Pelite, Aliplast, Plastazote or equal)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $181.97 / $758.58
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $251.19 / $323.59
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.20 / $257.04 / $537.03
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $426.58 / $812.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.78 / $218.78 / $218.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $162.18 / $218.78
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.33 / $281.84 / $1,737.80
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $158.49 / $2,041.74
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.55 / $245.47 / $338.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $158.49 / $239.88