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Oklahoma rates for HCPCS L5655

Addition to lower extremity, socket insert, below knee (BK) (Kemblo, Pelite, Aliplast, Plastazote or equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$157.93 / $157.93 / $157.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$157.93 / $180.49 / $180.49
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$219.31 / $322.31 / $322.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$221.07 / $221.07 / $221.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.38 / $221.07 / $221.07
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.53 / $221.09 / $1,741.43
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.88 / $209.88 / $372.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.88 / $165.98 / $239.25