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Ohio rates for HCPCS L5626

Addition to lower extremity, test socket, hip disarticulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$372.57 / $372.57 / $786.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$286.13 / $372.57 / $435.74
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$716.47 / $839.31 / $2,174.58
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$343.70 / $382.27 / $991.91
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$495.96 / $763.01 / $1,030.06
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$495.96 / $686.71 / $1,633.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$493.58 / $493.58 / $757.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$360.31 / $360.31 / $634.42
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$493.58 / $493.58 / $493.58
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$360.31 / $493.58 / $493.58
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.68 / $445.06 / $583.47
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$648.55 / $648.55 / $763.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$237.91 / $380.66 / $552.97