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Missouri rates for HCPCS L5696

Addition to lower extremity, above knee (AK) or knee disarticulation, pelvic joint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$108.30 / $160.19 / $165.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.30 / $124.09 / $225.62
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$237.05 / $248.90 / $1,094.22
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.11 / $133.38 / $191.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.76 / $138.76 / $138.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.29 / $101.29 / $147.91
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$108.30 / $191.04 / $1,184.51
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.33 / $128.12 / $226.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$296.08 / $296.08 / $355.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.25 / $118.26 / $170.72