go back

Oklahoma rates for HCPCS L5694

Addition to lower extremity, above knee (AK), pelvic control belt, padded and lined

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$124.57 / $124.57 / $124.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.57 / $130.78 / $142.36
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$172.98 / $254.22 / $254.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.85 / $140.85 / $140.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.82 / $102.82 / $252.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.13 / $174.37 / $1,167.33
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.42 / $143.54 / $283.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.42 / $130.91 / $163.66