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Missouri rates for HCPCS L5685

Addition to lower extremity prosthesis, below knee, suspension/sealing sleeve, with or without valve, any material, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.31 / $103.99 / $107.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.31 / $80.56 / $146.47
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.11 / $103.11 / $115.42
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$153.88 / $161.58 / $710.36
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.90 / $92.90 / $143.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.03 / $100.03 / $100.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.02 / $73.02 / $106.64
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.31 / $128.88 / $720.06
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.43 / $82.26 / $136.62
Qualchoice
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.99 / $142.99 / $142.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.43 / $77.34 / $109.12