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Missouri rates for HCPCS L5649

Addition to lower extremity, ischial containment/narrow M-L socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,044.03 / $1,544.30 / $1,593.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,044.03 / $1,464.52 / $2,175.07
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,531.08 / $1,713.89 / $1,713.89
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,285.19 / $2,399.44 / $10,548.44
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,299.83 / $1,559.80 / $1,879.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,800.00 / $1,800.00 / $1,800.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,314.00 / $1,314.00 / $2,110.78
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,062.50 / $1,936.99 / $11,959.60
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$950.05 / $1,288.00 / $2,474.44
Qualchoice
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,682.95 / $2,682.95 / $2,682.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$892.65 / $1,148.72 / $1,756.79