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Arizona rates for HCPCS L6629

Upper extremity addition, quick disconnect lamination collar with coupling piece, Otto Bock or equal

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.56 / $94.57 / $130.69
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.18 / $199.32 / $360.37
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.93 / $183.91 / $250.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$113.00 / $113.00 / $113.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.49 / $82.49 / $271.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.56 / $140.43 / $917.84
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.18 / $87.61 / $135.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.18 / $87.61 / $131.97