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Missouri rates for HCPCS L2628

Addition to lower extremity, pelvic control, metal frame, reciprocating hip joint and cables

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$988.09 / $988.09 / $1,316.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$970.13 / $1,024.02 / $1,562.98
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,887.48 / $1,981.85 / $8,712.61
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$943.18 / $1,137.16 / $1,527.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,179.41 / $1,179.41 / $1,179.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$860.97 / $860.97 / $1,214.79
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$988.09 / $1,527.74 / $10,013.70
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$780.15 / $941.64 / $2,294.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$725.52 / $941.64 / $1,451.04