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Arkansas rates for HCPCS L5695

Addition to lower extremity, above knee (AK), pelvic control, sleeve suspension, neoprene or equal, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$145.06 / $145.06 / $145.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.09 / $145.06 / $145.06
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.78 / $208.78 / $208.78
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
$225.30 / $298.19 / $331.32
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$200.99 / $200.99 / $228.41
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$228.41 / $228.41 / $228.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$122.31 / $122.31 / $208.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.29 / $122.31 / $203.89
Qualchoice
Facility/Professional
Professional
Modifier
Low / Median / High Price
$240.10 / $240.10 / $240.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.09 / $129.04 / $156.90