go back

Ohio rates for HCPCS L5696

Addition to lower extremity, above knee (AK) or knee disarticulation, pelvic joint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$115.45 / $115.45 / $283.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.04 / $115.45 / $160.19
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$222.02 / $260.08 / $673.85
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.47 / $133.38 / $307.37
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.33 / $236.44 / $319.19
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.69 / $212.80 / $506.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.76 / $138.76 / $291.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.29 / $101.29 / $177.27
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.76 / $138.76 / $138.76
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.29 / $138.76 / $138.76
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.30 / $137.91 / $180.81
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$251.68 / $251.68 / $296.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.64 / $117.96 / $170.72