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Missouri rates for HCPCS L5782

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,315.07 / $3,424.37 / $3,534.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,315.07 / $2,652.68 / $4,823.06
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,067.22 / $5,320.58 / $23,390.29
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,518.58 / $2,779.11 / $4,101.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,294.10 / $3,294.10 / $3,294.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,404.69 / $2,404.69 / $3,511.67
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,315.07 / $4,083.77 / $23,712.81
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,891.21 / $2,708.62 / $4,498.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,891.21 / $2,527.98 / $3,588.36