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Arkansas rates for HCPCS L5628

Addition To Lower Extremity Test Socket Hemipelvectomy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$383.25 / $383.25 / $383.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$260.39 / $383.25 / $383.25
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
$595.26 / $787.84 / $875.38
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$611.89 / $611.89 / $647.30
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$647.30 / $647.30 / $647.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$499.82 / $499.82 / $551.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$364.87 / $499.82 / $538.70
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$382.03 / $382.03 / $551.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$192.74 / $344.00 / $435.59