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Ohio rates for HCPCS L5505

Initial, above knee (AK), knee disarticulation, ischial level socket, nonalignable system, pylon, no cover, SACH foot, plaster socket, direct formed

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,222.80 / $1,222.80 / $2,917.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.66 / $1,222.80 / $1,597.51
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,351.53 / $2,754.72 / $7,137.23
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,253.83 / $1,275.38 / $3,255.57
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,627.79 / $2,504.29 / $3,380.79
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,627.79 / $2,253.86 / $5,362.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,620.00 / $1,620.00 / $2,764.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,182.59 / $1,182.59 / $2,069.55
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,620.00 / $1,620.00 / $1,620.00
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,182.59 / $1,620.00 / $1,620.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,365.94 / $2,365.94 / $2,783.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$832.91 / $1,249.36 / $1,604.89