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Missouri rates for HCPCS L5628

Addition To Lower Extremity Test Socket Hemipelvectomy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$277.50 / $410.47 / $423.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$277.50 / $382.42 / $578.12
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$607.39 / $637.76 / $2,803.71
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$337.79 / $352.40 / $491.63
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$499.82 / $499.82 / $499.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$364.87 / $364.87 / $514.80
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$277.50 / $489.52 / $3,076.44
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$240.92 / $328.27 / $618.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$382.03 / $438.64 / $607.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$231.25 / $326.63 / $445.50