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Arizona rates for HCPCS L5690

Addition to lower extremity, below knee (BK), waist belt, padded and lined

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.54 / $70.47 / $87.41
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.94 / $140.94 / $140.94
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.11 / $148.52 / $268.51
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.78 / $137.04 / $186.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.44 / $97.44 / $97.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.13 / $71.13 / $174.75
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.83 / $104.63 / $629.92
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.96 / $58.60 / $90.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.17 / $58.60 / $88.26