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Missouri rates for HCPCS L5520

Preparatory, below knee (BK) PTB type socket, nonalignable system, pylon, no cover, SACH foot, thermoplastic or equal, direct formed

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$962.48 / $1,423.66 / $1,469.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$943.17 / $1,102.83 / $2,005.16
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,106.66 / $2,211.98 / $9,724.34
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,028.03 / $1,054.47 / $1,704.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,232.72 / $1,232.72 / $1,232.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$899.89 / $899.89 / $1,269.70
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$962.29 / $1,697.81 / $9,329.16
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$717.58 / $1,126.08 / $1,841.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$717.58 / $1,051.00 / $1,491.84