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Missouri rates for HCPCS L5670

Addition to lower extremity, below knee (BK), molded supracondylar suspension (PTS or similar)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$147.91 / $218.78 / $218.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $190.55 / $478.63
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $245.47 / $245.47
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$331.13 / $331.13 / $1,174.90
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $194.98 / $309.03
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.53 / $199.53 / $331.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$147.91 / $204.17 / $204.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $147.91 / $204.17
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.82 / $263.03 / $724.44
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $173.78 / $2,137.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$213.80 / $263.03 / $263.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $162.18 / $245.47