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Arizona rates for HCPCS L5685

Addition to lower extremity prosthesis, below knee, suspension/sealing sleeve, with or without valve, any material, each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.91 / $69.55 / $115.71
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.19 / $113.19 / $116.21
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.61 / $143.13 / $258.79
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.05 / $132.07 / $173.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.03 / $100.03 / $100.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.02 / $73.02 / $179.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.49 / $97.11 / $720.06
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.28 / $68.92 / $106.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.71 / $68.92 / $103.80