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Oklahoma rates for HCPCS L5250

Hip disarticulation, Canadian type; molded socket, hip joint, single axis constant friction knee, shin, SACH foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,905.46 / $2,905.46 / $2,905.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,905.46 / $3,320.53 / $3,320.53
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,366.38 / $4,366.38 / $4,366.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,187.46 / $4,366.38 / $4,366.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,005.72 / $4,067.10 / $33,390.44
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,071.23 / $4,105.50 / $6,855.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,071.23 / $3,148.52 / $4,680.02