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Arizona rates for HCPCS L5698

Addition to lower extremity, above knee (AK) or knee disarticulation, Silesian bandage

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.60 / $74.09 / $117.27
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.22 / $156.15 / $282.31
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.07 / $144.09 / $196.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.25 / $99.25 / $99.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.45 / $72.45 / $166.88
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.32 / $110.02 / $682.16
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.45 / $62.46 / $96.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.10 / $82.54 / $94.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.45 / $62.46 / $94.08