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Missouri rates for HCPCS L5781

Addition to lower limb prosthesis, vacuum pump, residual limb volume management and moisture evacuation system

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,187.76 / $3,235.94 / $3,235.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,041.74 / $2,570.40 / $7,079.46
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,897.79 / $4,897.79 / $16,982.44
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,570.40 / $2,884.03 / $4,466.84
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,951.21 / $2,951.21 / $4,897.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,884.03 / $2,884.03 / $2,884.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,089.30 / $2,089.30 / $2,884.03
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,398.83 / $3,890.45 / $10,715.19
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $2,398.83 / $24,547.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,818.38 / $3,801.89 / $4,570.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $2,398.83 / $3,388.44