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Missouri rates for HCPCS L5500

Initial, below knee (BK) PTB type socket, nonalignable system, pylon, no cover, SACH foot, plaster socket, direct formed

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$922.56 / $1,364.63 / $1,408.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$881.11 / $1,057.10 / $1,691.37
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,019.31 / $2,120.28 / $9,321.12
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$925.84 / $1,359.89 / $1,707.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$963.22 / $963.22 / $963.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$703.15 / $703.15 / $992.12
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$859.42 / $1,585.67 / $8,261.60
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$671.61 / $1,016.24 / $1,572.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$671.61 / $1,015.06 / $1,429.98