go back

Missouri rates for HCPCS L5105

Below knee (BK), plastic socket, joints and thigh lacer, SACH foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,041.74 / $3,019.95 / $3,019.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $2,344.23 / $6,456.54
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,570.88 / $4,570.88 / $15,848.93
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,398.83 / $2,570.40 / $4,168.69
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,754.23 / $2,754.23 / $4,570.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,041.74 / $3,019.95 / $3,019.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,187.76 / $2,187.76 / $3,019.95
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,344.23 / $3,467.37 / $10,000.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,621.81 / $2,290.87 / $26,915.35
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,754.23 / $3,548.13 / $3,548.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,621.81 / $2,238.72 / $3,162.28