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Arizona rates for HCPCS L5696

Addition to lower extremity, above knee (AK) or knee disarticulation, pelvic joint

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.34 / $133.24 / $192.42
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.06 / $256.72 / $464.14
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.65 / $236.87 / $322.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.76 / $138.76 / $138.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.29 / $101.29 / $274.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.52 / $197.84 / $1,184.51
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.13 / $110.79 / $170.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.43 / $110.79 / $169.54