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Ohio rates for HCPCS L5622

Addition to lower extremity, test socket, knee disarticulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$235.43 / $235.43 / $687.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$217.56 / $235.43 / $365.77
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$452.74 / $530.37 / $1,374.13
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$241.55 / $263.79 / $626.79
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$361.61 / $482.15 / $650.90
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$313.39 / $433.94 / $1,032.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$274.54 / $274.54 / $579.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$200.41 / $200.41 / $400.90
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$274.54 / $274.54 / $274.54
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$200.41 / $274.54 / $274.54
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.52 / $281.22 / $368.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.36 / $240.54 / $334.51