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Missouri rates for HCPCS L5616

Addition to lower extremity, endoskeletal system, above knee (AK), universal multiplex system, friction swing phase control

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$872.00 / $1,289.83 / $1,331.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$872.00 / $999.17 / $1,816.67
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,908.63 / $2,004.06 / $8,810.24
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$931.39 / $979.06 / $1,544.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,018.60 / $1,018.60 / $1,018.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$743.58 / $743.58 / $743.58
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$872.00 / $1,538.20 / $8,447.07
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$677.71 / $1,020.23 / $1,738.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$677.71 / $952.20 / $1,362.50