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Missouri rates for HCPCS L5655

Addition to lower extremity, socket insert, below knee (BK) (Kemblo, Pelite, Aliplast, Plastazote or equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$145.44 / $215.14 / $222.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$145.44 / $169.14 / $303.01
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$318.35 / $334.27 / $1,469.50
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$168.92 / $201.58 / $257.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$221.07 / $221.07 / $221.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.38 / $161.38 / $235.67
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$148.02 / $256.57 / $1,741.43
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.36 / $172.06 / $301.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.36 / $168.14 / $244.74