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Missouri rates for HCPCS L5620

Addition to lower extremity, test socket, below knee (BK)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$154.88 / $229.09 / $229.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $194.98 / $489.78
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $257.04 / $269.15
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$346.74 / $346.74 / $1,202.26
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $204.17 / $323.59
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.93 / $208.93 / $346.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.82 / $208.93 / $208.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $151.36 / $208.93
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.83 / $275.42 / $758.58
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $177.83 / $2,187.76
Qualchoice
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $407.38 / $416.87
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.78 / $269.15 / $269.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $169.82 / $251.19