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Missouri rates for HCPCS L5624

Addition to lower extremity, test socket, above knee (AK)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$199.53 / $295.12 / $295.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.53 / $257.04 / $630.96
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $295.12 / $331.13
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $446.68 / $1,548.82
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $263.03 / $407.38
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $269.15 / $446.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.78 / $309.03 / $309.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $229.09 / $309.03
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$229.09 / $354.81 / $977.24
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $234.42 / $2,884.03
Qualchoice
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $537.03 / $537.03
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.40 / $346.74 / $346.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $218.78 / $331.13