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Missouri rates for HCPCS L6642

Upper extremity addition, excursion amplifier, lever type

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$146.49 / $216.68 / $223.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$146.49 / $172.23 / $305.18
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$320.62 / $336.65 / $1,479.98
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$156.75 / $159.44 / $259.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$225.10 / $225.10 / $225.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$164.32 / $164.32 / $231.85
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$145.50 / $258.41 / $1,446.87
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.51 / $172.06 / $278.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$172.06 / $197.55 / $320.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.64 / $159.96 / $214.25