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Missouri rates for HCPCS L5699

All lower extremity prostheses, shoulder harness

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.24 / $151.24 / $156.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.24 / $121.85 / $213.01
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$223.79 / $234.98 / $1,033.01
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.46 / $136.93 / $181.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.96 / $169.96 / $169.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.07 / $124.07 / $124.07
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.05 / $187.45 / $1,197.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.04 / $122.82 / $230.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.42 / $120.95 / $169.39