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Arkansas rates for HCPCS L5694

Addition to lower extremity, above knee (AK), pelvic control belt, padded and lined

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$161.37 / $161.37 / $161.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.25 / $161.37 / $161.37
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
$250.63 / $331.72 / $368.58
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$217.74 / $217.74 / $217.74
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$217.74 / $217.74 / $217.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.85 / $140.85 / $232.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.82 / $102.82 / $218.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.53 / $144.84 / $174.19