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Kansas 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
$163.72 / $163.72 / $163.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.13 / $113.99 / $182.38
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$168.33 / $183.65 / $194.80
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$182.29 / $182.29 / $182.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.85 / $140.85 / $140.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.82 / $102.82 / $315.47
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.13 / $173.55 / $1,167.33
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.42 / $124.67 / $278.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.42 / $124.67 / $167.39