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Missouri rates for HCPCS L5971

All lower extremity prostheses, solid ankle cushion heel (SACH) foot, replacement only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$114.98 / $170.07 / $175.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.98 / $131.75 / $239.54
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$251.67 / $264.25 / $1,161.71
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$133.12 / $148.22 / $203.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$159.21 / $159.21 / $159.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.22 / $116.22 / $169.72
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$114.98 / $210.80 / $1,295.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.34 / $136.02 / $231.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.82 / $126.51 / $187.40