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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
$242.56 / $242.56 / $242.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.90 / $242.56 / $242.56
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
$376.73 / $498.62 / $554.02
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.40 / $436.40 / $462.35
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$462.35 / $462.35 / $462.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$349.12 / $366.26 / $366.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$262.37 / $340.94 / $366.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$145.13 / $217.72 / $328.04