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Ohio rates for HCPCS L5613

Addition to lower extremity, endoskeletal system, above knee (AK), knee disarticulation, four-bar linkage, with hydraulic swing phase control

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,436.25 / $1,436.25 / $4,056.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,399.85 / $1,436.25 / $2,420.06
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,762.00 / $3,235.57 / $8,383.08
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,473.67 / $1,766.63 / $3,882.68
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,206.07 / $2,941.43 / $3,970.93
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,965.24 / $2,941.43 / $6,298.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,902.78 / $1,902.78 / $3,795.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,389.03 / $1,389.03 / $2,430.80
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,902.78 / $1,902.78 / $1,902.78
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,389.03 / $1,902.78 / $1,902.78
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,247.80 / $1,715.72 / $2,249.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$978.30 / $1,467.45 / $2,261.29