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Missouri rates for HCPCS L5658

Addition To Lower Extremity Socket Insert Above Knee (Kemblo Pelite Aliplast Plastazote Or Equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$240.06 / $355.09 / $366.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$240.06 / $275.07 / $500.12
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$525.42 / $551.70 / $2,425.38
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$262.11 / $266.11 / $425.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$366.26 / $366.26 / $366.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$267.37 / $267.37 / $390.45
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$240.06 / $423.46 / $2,323.85
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.43 / $280.86 / $465.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.43 / $262.13 / $372.09