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Arizona rates for HCPCS L5697

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.10 / $57.81 / $83.48
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.83 / $111.38 / $201.37
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.08 / $102.78 / $140.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.21 / $60.21 / $60.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.95 / $43.95 / $130.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.03 / $85.84 / $510.07
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.45 / $48.07 / $74.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.45 / $48.07 / $72.41