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Oklahoma rates for HCPCS L5685

Addition to lower extremity prosthesis, below knee, suspension/sealing sleeve, with or without valve, any material, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.68 / $66.68 / $66.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.68 / $76.20 / $76.94
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.97 / $136.09 / $136.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.03 / $100.03 / $100.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.02 / $100.03 / $100.03
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.49 / $93.35 / $720.06
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.94 / $91.07 / $153.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.94 / $74.08 / $103.80