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Missouri rates for HCPCS L5622

Addition to lower extremity, test socket, knee disarticulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$199.98 / $295.81 / $305.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.98 / $254.01 / $416.63
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$293.27 / $293.27 / $293.27
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$437.72 / $459.61 / $2,020.52
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$242.43 / $263.79 / $354.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$274.54 / $274.54 / $274.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$200.41 / $200.41 / $200.41
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$199.98 / $352.76 / $2,359.33
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$180.90 / $240.54 / $464.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$167.26 / $220.03 / $334.51