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Missouri rates for HCPCS L5230

Above knee (AK), for proximal femoral focal deficiency, constant friction knee, shin, SACH foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,226.06 / $3,292.72 / $3,398.17
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,226.06 / $2,849.21 / $4,637.63
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,872.41 / $5,116.03 / $22,491.04
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,709.74 / $2,776.59 / $3,941.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,853.06 / $2,853.06 / $2,853.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,082.73 / $2,082.73 / $2,938.65
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,226.06 / $3,926.77 / $24,371.76
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,898.24 / $2,633.36 / $4,870.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,855.05 / $2,430.79 / $3,510.16