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Missouri rates for HCPCS L5626

Addition to lower extremity, test socket, hip disarticulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$267.36 / $395.47 / $408.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$267.36 / $377.64 / $557.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$585.20 / $614.46 / $2,701.28
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$325.45 / $345.85 / $473.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$493.58 / $493.58 / $493.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$360.31 / $360.31 / $526.19
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$267.36 / $471.63 / $3,080.66
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$237.91 / $322.55 / $610.41
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$763.01 / $763.01 / $915.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$222.80 / $291.95 / $439.93