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Missouri rates for HCPCS L5975

All lower extremity prostheses, combination single axis ankle and flexible keel foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$254.42 / $376.34 / $388.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$254.42 / $291.52 / $530.04
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$556.88 / $584.72 / $2,570.56
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$284.27 / $305.45 / $450.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$362.03 / $362.03 / $362.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$264.27 / $264.27 / $385.94
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$254.42 / $466.44 / $2,615.79
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$207.86 / $297.68 / $494.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$207.86 / $281.80 / $394.36