go back

Missouri rates for HCPCS L5631

Addition to lower extremity, above knee (AK) or knee disarticulation, acrylic socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$240.94 / $356.38 / $367.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$240.94 / $281.08 / $501.95
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$353.33 / $353.33 / $395.52
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$527.36 / $553.73 / $2,434.29
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.52 / $319.89 / $426.66
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$329.53 / $329.53 / $329.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$240.56 / $240.56 / $351.29
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$240.94 / $425.01 / $2,777.21
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$219.25 / $292.82 / $562.52
Qualchoice
Facility/Professional
Professional
Modifier
Low / Median / High Price
$646.90 / $646.90 / $646.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$202.71 / $265.08 / $405.42