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Ohio rates for HCPCS L5658

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$267.57 / $267.57 / $536.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$226.72 / $267.57 / $355.09
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$514.54 / $602.78 / $1,561.74
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$262.11 / $274.55 / $712.37
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$356.19 / $547.98 / $739.77
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$356.19 / $493.18 / $1,173.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$366.26 / $366.26 / $571.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$267.37 / $267.37 / $455.64
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$366.26 / $366.26 / $366.26
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$267.37 / $366.26 / $366.26
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$232.47 / $319.64 / $419.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.43 / $273.38 / $345.30