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Arizona rates for HCPCS L5695

Addition to lower extremity, above knee (AK), pelvic control, sleeve suspension, neoprene or equal, each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.92 / $117.44 / $149.60
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$68.52 / $247.53 / $447.52
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$171.29 / $228.39 / $311.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$122.31 / $122.31 / $122.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.29 / $89.29 / $226.88
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.04 / $174.38 / $1,037.98
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.26 / $97.65 / $150.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.26 / $97.65 / $150.47