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Missouri rates for HCPCS L5220

Above knee (AK), short prosthesis, no knee joint (stubbies), with articulated ankle/foot, dynamically aligned, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,672.10 / $2,473.32 / $2,552.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,672.10 / $1,915.95 / $3,483.55
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,659.90 / $3,842.90 / $16,894.09
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,948.39 / $1,988.34 / $2,961.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,482.86 / $2,482.86 / $2,482.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,812.49 / $1,812.49 / $2,646.85
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,672.10 / $2,949.59 / $17,674.86
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,376.34 / $1,956.36 / $3,390.62
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,182.50 / $2,487.91 / $2,927.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,376.34 / $1,825.88 / $2,591.76