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Arizona rates for HCPCS L5699

All lower extremity prostheses, shoulder harness

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.90 / $134.27 / $211.26
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$78.34 / $282.99 / $511.63
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$195.84 / $261.12 / $355.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.96 / $169.96 / $169.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.07 / $124.07 / $285.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.08 / $199.37 / $1,197.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.91 / $111.65 / $172.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.91 / $111.65 / $168.18