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Oklahoma rates for HCPCS L5595

Preparatory, hip disarticulation/hemipelvectomy, pylon, no cover, SACH foot, thermoplastic or equal, molded to patient model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,073.55 / $2,073.55 / $2,073.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,073.55 / $2,369.77 / $2,522.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,578.08 / $3,578.08 / $3,578.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,612.00 / $2,612.00 / $6,412.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,556.51 / $2,902.58 / $25,854.57
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,607.34 / $3,186.02 / $4,892.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,607.34 / $2,310.37 / $3,631.86