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Arkansas rates for HCPCS L5595

Preparatory, hip disarticulation/hemipelvectomy, pylon, no cover, SACH foot, thermoplastic or equal, molded to patient model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,686.16 / $2,686.16 / $2,686.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,182.98 / $2,686.16 / $2,686.16
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$219,999.78 / $539,999.46 / $949,999.05
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,172.04 / $5,521.82 / $6,135.35
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,071.58 / $5,071.58 / $5,097.28
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,071.58 / $5,071.58 / $5,071.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,578.08 / $3,578.08 / $3,866.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,612.00 / $2,612.00 / $3,631.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,607.34 / $2,411.02 / $3,632.67