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Oklahoma rates for HCPCS L5975

All lower extremity prostheses, combination single axis ankle and flexible keel foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$241.42 / $241.42 / $241.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$241.42 / $275.91 / $278.52
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$492.70 / $492.70 / $492.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$362.03 / $362.03 / $362.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$264.27 / $362.03 / $362.03
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$161.02 / $337.94 / $2,615.79
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.28 / $329.60 / $569.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.28 / $268.20 / $375.73