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Missouri rates for HCPCS L6687

Upper extremity addition, frame type socket, below elbow or wrist disarticulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$316.30 / $467.85 / $482.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.30 / $362.42 / $658.95
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$692.31 / $726.93 / $3,195.70
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$351.66 / $420.80 / $560.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$432.60 / $432.60 / $432.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$315.80 / $315.80 / $461.17
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$316.30 / $557.95 / $3,605.80
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$287.83 / $374.17 / $611.59
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$456.41 / $524.04 / $692.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$270.44 / $345.39 / $528.54