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Arizona rates for HCPCS L5975

All lower extremity prostheses, combination single axis ankle and flexible keel foot

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $281.84 / $1,096.48
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.54 / $331.13 / $691.83
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $549.54 / $1,047.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$363.08 / $363.08 / $363.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $263.03 / $363.08
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.18 / $363.08 / $2,630.27
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $251.19 / $2,818.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.55 / $380.19 / $436.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $251.19 / $371.54