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Arizona rates for HCPCS L5694

Addition To Lower Extremity Above Knee Pelvic Control Belt Padded And Lined

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.41 / $130.63 / $187.93
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$261.29 / $261.29 / $261.29
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$76.22 / $275.33 / $497.79
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $254.06 / $346.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.85 / $140.85 / $140.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.82 / $102.82 / $252.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.13 / $193.98 / $1,167.33
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.18 / $108.63 / $167.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.18 / $108.63 / $163.63