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Oklahoma rates for HCPCS L5697

Addition to lower extremity, above knee (AK) or knee disarticulation, pelvic band

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.74 / $40.74 / $40.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.69 / $54.95 / $93.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.26 / $60.26 / $60.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.65 / $43.65 / $104.71
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.69 / $61.66 / $295.12
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $54.95 / $125.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.10 / $77.62 / $112.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $45.71 / $72.44