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Oklahoma rates for HCPCS L5628

Addition To Lower Extremity Test Socket Hemipelvectomy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$295.85 / $295.85 / $295.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.85 / $338.12 / $338.12
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$410.83 / $603.78 / $603.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$499.82 / $499.82 / $499.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$364.87 / $499.82 / $499.82
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.64 / $414.14 / $3,076.44
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$192.74 / $382.03 / $698.02
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$240.92 / $240.92 / $240.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$192.74 / $328.66 / $435.50