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Oklahoma rates for HCPCS L5856

Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing and stance phase, includes electronic sensor(s), any type

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,500.49 / $12,500.49 / $12,500.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12,500.48 / $12,500.49 / $14,421.30
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24,764.33 / $24,764.33 / $24,764.33
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20,800.00 / $25,511.20 / $25,511.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16,200.25 / $16,200.25 / $16,200.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11,826.18 / $16,200.25 / $16,200.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,350.18 / $17,498.29 / $134,932.92
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,622.87 / $17,091.93 / $28,451.67
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29,383.10 / $29,383.10 / $29,383.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,622.87 / $13,886.88 / $19,483.75