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Missouri rates for HCPCS L5613

Addition To Lower Extremity Endoskeletal System Above Knee- Knee Disarticulation 4 Bar Linkage With Hydraulic Swing Phase Control

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,636.10 / $2,420.06 / $2,497.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,455.84 / $1,874.70 / $3,408.54
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,581.09 / $3,760.14 / $16,530.31
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,747.54 / $1,788.71 / $2,897.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,902.78 / $1,902.78 / $1,902.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,389.03 / $1,389.03 / $1,959.86
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,636.10 / $2,886.07 / $15,444.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,222.88 / $1,914.24 / $3,124.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,191.04 / $1,786.57 / $2,392.80