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Missouri rates for HCPCS L5677

Additions to lower extremity, below knee (BK), knee joints, polycentric, pair

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$290.83 / $430.20 / $443.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$290.83 / $345.46 / $605.91
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$636.59 / $668.42 / $2,938.50
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.15 / $359.88 / $515.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$400.78 / $400.78 / $400.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.57 / $292.57 / $427.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$290.83 / $513.04 / $3,128.35
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$246.03 / $344.05 / $631.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$246.03 / $333.55 / $638.86