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Missouri rates for HCPCS L5595

Preparatory, hip disarticulation/hemipelvectomy, pylon, no cover, SACH foot, thermoplastic or equal, molded to patient model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,207.94 / $3,265.93 / $3,370.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,207.94 / $2,737.63 / $4,599.89
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,832.77 / $5,074.41 / $22,308.07
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,687.68 / $2,952.48 / $3,909.92
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,578.08 / $3,578.08 / $3,578.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,612.00 / $2,612.00 / $2,612.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,247.02 / $3,894.83 / $25,854.57
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,009.18 / $2,624.48 / $4,886.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,839.96 / $2,611.92 / $3,817.44