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Missouri rates for HCPCS L5668

Addition to lower extremity, below knee (BK), molded distal cushion

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.04 / $82.89 / $85.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.04 / $70.76 / $116.75
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.00 / $92.00 / $92.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$122.66 / $128.79 / $566.20
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.15 / $80.98 / $100.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.19 / $89.19 / $89.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.11 / $65.11 / $95.08
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.04 / $100.87 / $645.28
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.39 / $68.12 / $129.29
Qualchoice
Facility/Professional
Professional
Modifier
Low / Median / High Price
$148.68 / $148.68 / $148.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.34 / $61.20 / $93.18