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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
$63.59 / $94.06 / $97.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.59 / $72.86 / $132.47
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$139.18 / $146.13 / $642.45
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.23 / $76.13 / $112.66
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.25 / $99.25 / $99.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.45 / $72.45 / $72.45
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.72 / $117.27 / $682.16
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.05 / $74.47 / $127.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$82.54 / $94.76 / $139.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.05 / $69.44 / $99.36