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Ohio rates for HCPCS L5624

Addition to lower extremity, test socket, above knee (AK)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$235.34 / $235.34 / $588.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.86 / $235.34 / $317.83
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$361.48 / $361.48 / $361.48
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$452.57 / $530.16 / $1,373.61
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$235.12 / $262.13 / $626.55
Aultcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$409.67 / $409.67 / $409.67
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$361.48 / $481.97 / $650.66
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$313.27 / $433.77 / $1,031.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$311.77 / $311.77 / $567.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$227.60 / $227.60 / $398.30
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$311.77 / $311.77 / $311.77
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$227.60 / $311.77 / $311.77
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$260.56 / $358.28 / $469.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.30 / $240.44 / $335.46