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Oklahoma rates for HCPCS L5857

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,435.64 / $4,435.64 / $4,435.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,435.64 / $5,069.32 / $5,117.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,652.12 / $6,652.12 / $6,652.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,856.05 / $6,652.12 / $6,652.12
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,970.74 / $6,209.06 / $48,028.27
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,067.77 / $6,080.81 / $10,465.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,067.77 / $4,927.60 / $6,931.74