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Oklahoma rates for HCPCS L5658

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$187.24 / $187.24 / $187.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$187.24 / $213.99 / $215.99
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$370.94 / $370.94 / $370.94
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$260.01 / $382.13 / $382.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$366.26 / $366.26 / $366.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$267.37 / $366.26 / $366.26
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.55 / $262.10 / $2,323.85
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$145.13 / $287.70 / $441.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$145.13 / $217.72 / $327.96