go back

Missouri rates for HCPCS L5698

Addition to lower extremity, above knee (AK) or knee disarticulation, Silesian bandage

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.10 / $93.33 / $93.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $75.86 / $204.17
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$141.25 / $141.25 / $501.19
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $75.86 / $131.83
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $85.11 / $141.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.57 / $100.00 / $100.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $72.44 / $100.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.18 / $117.49 / $309.03
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $72.44 / $794.33
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.18 / $112.20 / $112.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $69.18 / $97.72