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Missouri rates for HCPCS L5639

Addition to lower extremity, below knee (BK), wood socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$614.79 / $909.40 / $938.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$614.79 / $704.46 / $1,280.83
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,345.68 / $1,412.96 / $6,211.66
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$683.53 / $822.12 / $1,088.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$870.50 / $870.50 / $870.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$635.47 / $635.47 / $896.62
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$614.79 / $1,084.52 / $7,424.54
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$559.46 / $727.29 / $1,429.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$517.27 / $671.35 / $1,027.33