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Missouri rates for HCPCS L5614

Addition to lower extremity, exoskeletal system, above knee (AK), knee disarticulation, four-bar linkage, with pneumatic swing phase control

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$926.14 / $1,369.91 / $1,413.77
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$926.14 / $1,061.20 / $1,929.45
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,027.13 / $2,128.48 / $9,357.23
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,034.76 / $1,111.77 / $1,640.63
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,317.79 / $1,317.79 / $1,317.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$961.99 / $961.99 / $1,357.32
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$926.14 / $1,633.69 / $9,502.08
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$756.58 / $1,083.58 / $1,799.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$756.58 / $1,019.00 / $1,435.51