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Ohio rates for HCPCS L5975

All lower extremity prostheses, combination single axis ankle and flexible keel foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$273.27 / $273.27 / $643.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$266.35 / $273.27 / $376.34
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$525.53 / $615.64 / $1,595.06
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$280.39 / $305.45 / $727.57
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$419.75 / $559.66 / $755.55
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$365.77 / $506.46 / $1,198.36
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$362.03 / $362.03 / $659.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$264.27 / $264.27 / $462.49
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$362.03 / $362.03 / $362.03
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$264.27 / $362.03 / $362.03
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$276.51 / $380.20 / $498.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.14 / $279.20 / $384.36