go back

Missouri rates for HCPCS L5637

Addition to lower extremity, below knee (BK), total contact

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$158.41 / $234.32 / $241.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.41 / $228.82 / $330.03
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$232.32 / $232.32 / $260.06
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$346.74 / $364.08 / $1,600.55
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$192.83 / $210.73 / $280.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$232.98 / $232.98 / $232.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.08 / $170.08 / $273.20
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$158.41 / $279.44 / $1,951.09
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.15 / $195.43 / $375.45
Qualchoice
Facility/Professional
Professional
Modifier
Low / Median / High Price
$425.33 / $425.33 / $425.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.15 / $172.98 / $266.56