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Ohio rates for HCPCS L5706

Custom Shaped Protective Cover Knee Disarticulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$659.24 / $659.24 / $1,638.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$595.38 / $659.24 / $820.55
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,267.76 / $1,485.13 / $3,847.84
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.97 / $676.42 / $1,755.15
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$945.58 / $1,350.12 / $1,822.66
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$877.58 / $1,215.10 / $2,890.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$957.73 / $957.73 / $1,402.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$699.14 / $699.14 / $1,122.59
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$957.73 / $957.73 / $957.73
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$699.14 / $957.73 / $957.73
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$572.74 / $787.52 / $1,032.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$595.23 / $595.23 / $595.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$449.04 / $673.56 / $857.01