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Missouri rates for HCPCS L5647

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$581.60 / $860.28 / $887.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$472.54 / $666.41 / $1,211.66
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$852.91 / $852.91 / $954.75
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,273.00 / $1,336.65 / $5,876.17
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$573.42 / $581.25 / $1,029.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$596.58 / $596.58 / $596.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$435.50 / $435.50 / $435.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$530.66 / $956.66 / $5,050.38
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$423.39 / $635.08 / $1,014.28
Qualchoice
Facility/Professional
Professional
Modifier
Low / Median / High Price
$878.37 / $878.37 / $878.37
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$629.41 / $717.49 / $1,018.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$423.39 / $635.08 / $850.58