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Missouri rates for HCPCS L5656

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$229.09 / $338.84 / $338.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.98 / $263.03 / $741.31
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$512.86 / $512.86 / $1,819.70
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $269.15 / $478.63
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $309.03 / $512.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$229.09 / $338.84 / $338.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $245.47 / $338.84
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.47 / $398.11 / $1,122.02
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $251.19 / $2,951.21
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$295.12 / $407.38 / $478.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $251.19 / $354.81