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Oklahoma rates for HCPCS L5699

All lower extremity prostheses, shoulder harness

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$96.02 / $96.02 / $96.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.02 / $109.74 / $134.41
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$133.34 / $195.96 / $195.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.96 / $169.96 / $169.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.07 / $124.07 / $285.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.08 / $134.41 / $1,197.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.43 / $147.53 / $226.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.43 / $106.99 / $168.18