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Missouri rates for HCPCS L5301

Below knee (BK), molded socket, shin, SACH foot, endoskeletal system

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,426.61 / $2,110.19 / $2,177.77
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,426.61 / $1,634.66 / $2,972.09
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,092.11 / $2,092.11 / $2,341.91
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,122.55 / $3,278.68 / $14,413.69
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,599.68 / $1,972.92 / $2,568.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,721.98 / $1,721.98 / $1,721.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,257.05 / $1,257.05 / $2,019.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,451.84 / $2,516.53 / $14,785.52
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,145.70 / $1,669.13 / $2,857.19
Qualchoice
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,045.35 / $3,045.35 / $3,045.35
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,674.38 / $3,674.38 / $4,409.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,145.70 / $1,569.65 / $2,229.08