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Ohio rates for HCPCS L5629

Addition to lower extremity, below knee, acrylic socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.25 / $186.25 / $486.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.25 / $186.25 / $320.64
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$358.16 / $419.57 / $1,087.08
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.08 / $223.29 / $502.93
Aultcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$324.22 / $324.22 / $324.22
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$286.07 / $381.43 / $534.00
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$247.93 / $381.43 / $816.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$248.05 / $248.05 / $492.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.08 / $181.08 / $316.88
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$248.05 / $248.05 / $248.05
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.08 / $248.05 / $248.05
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.80 / $222.48 / $291.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$126.86 / $190.30 / $293.23