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Arizona rates for HCPCS L5694

Addition to lower extremity, above knee (AK), pelvic control belt, padded and lined

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $128.82 / $575.44
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $263.03 / $263.03
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.86 / $173.78 / $371.54
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $295.12 / $549.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$141.25 / $141.25 / $141.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $102.33 / $141.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.79 / $194.98 / $1,174.90
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $109.65 / $1,513.56
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.54 / $165.96 / $234.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $109.65 / $162.18