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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
$41.34 / $41.34 / $41.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.34 / $47.25 / $47.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.21 / $60.21 / $60.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.95 / $60.21 / $60.21
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.03 / $57.87 / $510.07
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.04 / $63.52 / $97.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.04 / $48.07 / $72.09