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Ohio rates for HCPCS L5642

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$400.35 / $400.35 / $999.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$366.25 / $400.35 / $559.50
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$769.90 / $901.91 / $2,336.77
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$410.79 / $454.30 / $1,065.89
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$560.17 / $819.92 / $1,106.89
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$532.95 / $737.93 / $1,755.61
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$530.41 / $530.41 / $913.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$387.20 / $387.20 / $681.75
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$530.41 / $530.41 / $530.41
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$387.20 / $530.41 / $530.41
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$347.83 / $478.26 / $627.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$272.70 / $409.05 / $594.21