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Missouri rates for HCPCS L8417

Prosthetic sheath/sock, including a gel cushion layer, below knee (BK) or above knee (AK), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.27 / $61.05 / $63.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.27 / $47.29 / $75.66
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.53 / $60.53 / $60.53
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$90.34 / $94.86 / $417.01
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.14 / $54.54 / $73.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.66 / $50.66 / $50.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.97 / $36.97 / $54.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.27 / $72.81 / $423.35
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.71 / $48.29 / $80.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.71 / $45.07 / $64.04