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Missouri rates for HCPCS L5632

Addition to lower extremity, Symes type, PTB brim design socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.08 / $204.24 / $210.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.08 / $160.88 / $287.66
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.22 / $317.33 / $1,395.05
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.06 / $175.88 / $244.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$166.52 / $166.52 / $166.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$121.56 / $121.56 / $177.52
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.08 / $243.58 / $1,389.02
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.80 / $162.16 / $284.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.80 / $150.78 / $204.88