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Missouri rates for HCPCS L5617

Addition to lower extremity, quick change self-aligning unit, above knee (AK) or below knee (BK), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$306.76 / $453.75 / $468.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$306.76 / $351.49 / $639.08
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$671.44 / $705.01 / $3,099.37
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$343.11 / $405.82 / $543.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.96 / $436.96 / $436.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$318.98 / $318.98 / $450.07
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$306.76 / $541.12 / $3,169.20
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$252.47 / $358.90 / $596.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$252.47 / $334.97 / $475.48