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Ohio rates for HCPCS L5656

Addition to lower extremity, socket insert, knee disarticulation (Kemblo, Pelite, Aliplast, Plastazote or equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$253.50 / $253.50 / $603.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.72 / $253.50 / $366.85
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$487.49 / $571.08 / $1,479.61
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$260.11 / $270.76 / $674.90
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$356.07 / $519.16 / $700.87
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$337.45 / $467.24 / $1,111.63
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$335.84 / $335.84 / $575.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.16 / $245.16 / $431.67
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$335.84 / $335.84 / $335.84
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.16 / $335.84 / $335.84
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$220.24 / $302.84 / $397.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$172.67 / $259.00 / $342.28