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Missouri rates for HCPCS L5850

Addition, endoskeletal system, above knee (AK) or hip disarticulation, knee extension assist

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.15 / $103.76 / $107.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.15 / $81.84 / $146.13
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.87 / $115.16 / $115.16
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$153.54 / $161.22 / $708.74
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.73 / $93.24 / $124.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.32 / $99.32 / $99.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.50 / $72.50 / $105.87
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.15 / $123.74 / $799.68
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.84 / $82.99 / $163.77
Qualchoice
Facility/Professional
Professional
Modifier
Low / Median / High Price
$188.34 / $188.34 / $188.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.84 / $76.59 / $118.04