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Missouri rates for HCPCS L5654

Addition to lower extremity, socket insert, Symes, (Kemblo, Pelite, Aliplast, Plastazote or equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.39 / $287.54 / $296.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.39 / $234.26 / $404.98
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$425.48 / $446.75 / $1,964.02
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$233.94 / $240.07 / $344.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$306.16 / $306.16 / $306.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.50 / $223.50 / $326.39
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.39 / $342.89 / $2,089.06
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.49 / $229.96 / $422.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.99 / $212.27 / $306.01