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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
$230.49 / $340.93 / $351.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$230.49 / $264.10 / $480.19
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$504.49 / $529.71 / $2,328.73
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.72 / $270.76 / $408.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$335.84 / $335.84 / $335.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.16 / $245.16 / $245.16
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$230.49 / $406.59 / $2,344.02
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$185.10 / $269.68 / $458.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$185.10 / $251.69 / $351.69