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Missouri rates for HCPCS L5671

Addition to lower extremity, below knee (BK)/above knee (AK) suspension locking mechanism (shuttle, lanyard, or equal), excludes socket insert

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$363.68 / $537.95 / $555.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.49 / $416.72 / $757.66
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$533.34 / $533.34 / $597.02
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$796.03 / $835.83 / $3,674.47
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$358.64 / $412.43 / $644.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.63 / $380.63 / $380.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$277.86 / $277.86 / $405.78
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$332.85 / $640.12 / $3,301.32
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$264.75 / $397.13 / $593.69
Qualchoice
Facility/Professional
Professional
Modifier
Low / Median / High Price
$634.87 / $634.87 / $634.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$264.75 / $397.13 / $563.71