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Oklahoma rates for HCPCS L5654

Addition to lower extremity, socket insert, Symes, (Kemblo, Pelite, Aliplast, Plastazote or equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$203.01 / $203.01 / $203.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$203.01 / $232.01 / $232.01
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.89 / $414.31 / $414.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$306.16 / $306.16 / $306.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.50 / $306.16 / $306.16
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.19 / $284.17 / $2,089.06
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.38 / $262.42 / $478.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.38 / $213.34 / $299.14