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Oklahoma rates for HCPCS L5976

All lower extremity prostheses, energy storing foot (Seattle Carbon Copy II or equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$312.60 / $312.60 / $312.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$312.60 / $357.26 / $357.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$637.96 / $637.96 / $637.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$420.01 / $420.01 / $420.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$306.61 / $420.01 / $420.01
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$216.49 / $437.58 / $3,565.60
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.56 / $443.12 / $737.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.56 / $335.33 / $505.14