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Oregon rates for HCPCS L3100

Hallus-Valgus Night Dynamic Splint Prefabricated Off-The-Shelf (Revised 01/01/14) (Special Coverage Instructions Apply. See Mcm: 2323)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.55 / $30.50 / $146.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.89 / $34.89 / $34.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.47 / $25.47 / $34.89
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.59 / $98.72 / $128.75
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.47 / $41.79 / $50.84
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.79 / $47.79 / $53.38
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.36 / $50.84 / $55.92
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.76 / $50.84 / $52.65
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.50 / $43.62 / $53.38
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.47 / $44.52 / $55.92
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.36 / $84.56 / $178.37
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.72 / $55.92 / $55.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.85 / $23.21 / $44.29