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Arkansas rates for HCPCS L5697

Addition to lower extremity, above knee (AK) or knee disarticulation, pelvic band

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.56 / $53.56 / $53.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.26 / $53.56 / $53.56
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
$83.18 / $110.09 / $122.32
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$96.35 / $96.35 / $101.40
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.40 / $101.40 / $101.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.21 / $60.21 / $77.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.95 / $60.21 / $75.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.04 / $48.07 / $74.06