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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
$9,677.81 / $9,677.81 / $9,677.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,677.81 / $11,060.36 / $11,164.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,513.81 / $14,513.81 / $14,513.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,595.08 / $14,513.81 / $14,513.81
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,455.32 / $13,547.09 / $104,478.94
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,666.14 / $13,213.37 / $22,027.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,666.14 / $10,487.39 / $15,062.41