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Missouri rates for HCPCS L5976

All lower extremity prostheses, energy storing foot (Seattle Carbon Copy II or equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$345.91 / $511.66 / $528.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$345.91 / $396.36 / $720.65
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$757.14 / $795.00 / $3,494.96
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$378.33 / $409.90 / $612.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$420.01 / $420.01 / $420.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$306.61 / $306.61 / $447.75
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$345.91 / $610.17 / $3,565.60
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$279.45 / $404.71 / $657.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$279.45 / $378.86 / $536.16