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Ohio rates for HCPCS L5697

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.83 / $54.83 / $123.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.72 / $54.83 / $65.11
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$105.43 / $123.51 / $320.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.26 / $57.87 / $145.96
Aultcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.44 / $95.44 / $95.44
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$76.05 / $112.28 / $151.58
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.98 / $101.05 / $240.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.21 / $60.21 / $125.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.95 / $43.95 / $76.92
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.21 / $60.21 / $60.21
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.95 / $60.21 / $60.21
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.64 / $65.50 / $85.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.34 / $56.02 / $74.06