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Arizona rates for HCPCS L5668

Addition to lower extremity, below knee (BK), molded distal cushion

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $72.44 / $295.12
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $104.71 / $123.03
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.66 / $97.72 / $204.17
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $162.18 / $309.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.13 / $89.13 / $89.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $64.57 / $89.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.90 / $107.15 / $645.65
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $60.26 / $794.33
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.43 / $93.33 / $128.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $60.26 / $91.20