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Arkansas rates for HCPCS L5658

Addition to lower extremity, socket insert, above knee (AK) (Kemblo, Pelite, Aliplast, Plastazote or equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.88 / $239.88 / $239.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $208.93 / $407.38
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218,776.16 / $524,807.46 / $954,992.59
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $380.19 / $501.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$354.81 / $363.08 / $363.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $269.15 / $363.08
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.96 / $501.19 / $588.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $218.78 / $338.84