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Missouri rates for HCPCS L5828

Addition, endoskeletal knee-shin system, single axis, fluid swing and stance phase control

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,719.69 / $2,543.71 / $2,625.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,719.69 / $1,970.48 / $3,582.69
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,521.92 / $2,521.92 / $2,823.05
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,764.06 / $3,952.26 / $17,374.90
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,836.82 / $2,063.67 / $3,045.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,117.90 / $2,117.90 / $2,117.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,546.07 / $1,546.07 / $1,546.07
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,719.69 / $3,033.51 / $17,754.05
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,409.12 / $2,012.02 / $3,600.78
Qualchoice
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,118.26 / $3,118.26 / $3,118.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,409.12 / $1,877.84 / $2,605.67