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Missouri rates for HCPCS L5672

Addition to lower extremity, below knee (BK), removable medial brim suspension

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.06 / $250.06 / $258.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.06 / $213.31 / $352.20
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$370.03 / $388.53 / $1,708.06
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$205.79 / $217.64 / $299.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$297.81 / $297.81 / $297.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$217.40 / $217.40 / $306.74
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.06 / $298.22 / $1,867.83
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$148.79 / $201.72 / $380.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.88 / $184.60 / $275.14