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Missouri rates for HCPCS L5642

Addition to lower extremity, above knee (AK), leather socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$346.74 / $512.86 / $512.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $426.58 / $1,122.02
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $776.25 / $2,691.53
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.58 / $457.09 / $724.44
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $467.74 / $776.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$346.74 / $524.81 / $524.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.05 / $389.05 / $524.81
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.11 / $616.60 / $1,698.24
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $380.19 / $4,897.79
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $616.60 / $616.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $380.19 / $562.34