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Missouri rates for HCPCS L2795

Addition to lower extremity orthosis, knee control, full kneecap

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.12 / $50.12 / $66.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $51.94 / $79.27
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.80 / $71.80 / $71.80
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.73 / $100.52 / $441.89
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.86 / $57.96 / $77.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.69 / $62.81 / $62.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.85 / $45.85 / $66.95
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.08 / $77.48 / $501.46
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.57 / $47.76 / $116.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.79 / $47.76 / $82.91