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Missouri rates for HCPCS L5697

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.02 / $65.11 / $67.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.02 / $55.57 / $91.71
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$96.35 / $101.17 / $444.75
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.59 / $57.87 / $77.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.21 / $60.21 / $60.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.95 / $43.95 / $64.19
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.02 / $77.66 / $510.07
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.06 / $52.32 / $102.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.68 / $48.07 / $72.93