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Ohio rates for HCPCS L5631

Addition to lower extremity, above knee (AK) or knee disarticulation, acrylic socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$257.50 / $257.50 / $672.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.50 / $257.50 / $443.30
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$395.52 / $395.52 / $395.52
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$495.19 / $580.10 / $1,502.98
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.26 / $308.70 / $695.33
Aultcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$448.26 / $448.26 / $448.26
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$395.52 / $527.36 / $738.30
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$342.78 / $527.36 / $1,129.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$329.53 / $329.53 / $682.43
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$240.56 / $240.56 / $420.97
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$329.53 / $329.53 / $329.53
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$240.56 / $329.53 / $329.53
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$285.10 / $392.01 / $513.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.40 / $263.08 / $405.42