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Missouri rates for HCPCS L5505

Initial, above knee (AK), knee disarticulation, ischial level socket, nonalignable system, pylon, no cover, SACH foot, plaster socket, direct formed

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,080.00 / $1,597.51 / $1,648.67
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,080.00 / $1,239.49 / $2,250.01
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,363.91 / $2,482.11 / $10,911.81
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,253.83 / $1,275.38 / $1,912.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,620.00 / $1,620.00 / $1,620.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,182.59 / $1,182.59 / $1,668.60
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,080.00 / $1,905.13 / $11,250.63
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$867.90 / $1,263.60 / $2,226.77
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,783.46 / $2,783.46 / $3,340.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$867.90 / $1,188.30 / $1,748.26