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Missouri rates for HCPCS L5857

Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing phase only, includes electronic sensor(s), any type

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,672.02 / $6,910.70 / $7,132.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,672.02 / $5,353.36 / $9,733.37
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,226.12 / $10,737.43 / $47,203.77
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,223.35 / $5,635.06 / $8,411.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,652.12 / $6,652.12 / $6,652.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,856.05 / $4,856.05 / $6,851.68
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,672.02 / $8,241.44 / $48,028.27
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,834.71 / $5,466.25 / $9,084.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,834.71 / $5,101.70 / $7,241.63