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Arizona rates for HCPCS L5658

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$195.22 / $203.31 / $378.13
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$118.61 / $428.47 / $774.66
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$296.52 / $395.37 / $538.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$366.26 / $366.26 / $366.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$267.37 / $267.37 / $635.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.55 / $314.86 / $2,323.85
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$196.78 / $217.72 / $335.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$196.78 / $217.72 / $327.96