go back

Missouri rates for HCPCS L5650

Additions to lower extremity, total contact, above knee (AK) or knee disarticulation socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$267.70 / $395.97 / $408.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$267.70 / $306.74 / $557.71
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$392.58 / $392.58 / $439.46
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$585.94 / $615.24 / $2,704.70
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.79 / $355.30 / $474.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$379.03 / $379.03 / $379.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$276.69 / $276.69 / $276.69
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$267.70 / $472.22 / $3,128.86
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$243.60 / $318.20 / $572.21
Qualchoice
Facility/Professional
Professional
Modifier
Low / Median / High Price
$632.58 / $632.58 / $632.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$228.88 / $294.54 / $450.45