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Arkansas rates for HCPCS L5685

Addition To Lower Extremity Prosthesis Below Kneesuspension/Sealing Sleeve

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$86.39 / $86.39 / $86.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.68 / $86.39 / $86.39
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.34 / $124.34 / $124.34
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
$134.16 / $177.58 / $197.31
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$150.91 / $150.91 / $155.46
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.91 / $150.91 / $150.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.03 / $100.03 / $124.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.02 / $100.03 / $121.42
Qualchoice
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.99 / $142.99 / $142.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.94 / $77.54 / $103.86