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Oklahoma rates for HCPCS L5858

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,772.37 / $9,772.37 / $9,772.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,772.37 / $11,481.54 / $18,620.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,454.40 / $14,454.40 / $14,454.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,715.19 / $10,715.19 / $24,547.09
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,549.93 / $13,803.84 / $69,183.10
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,606.93 / $11,220.18 / $29,512.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,182.57 / $22,908.68 / $22,908.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,606.93 / $10,232.93 / $15,135.61