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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
$239.88 / $239.88 / $239.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $288.40 / $467.74
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $489.78 / $489.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$363.08 / $363.08 / $363.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $263.03 / $616.60
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.88 / $346.74 / $1,737.80
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $323.59 / $741.31
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$331.13 / $575.44 / $575.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $251.19 / $371.54