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Oregon rates for HCPCS L5643

Addition to lower extremity, hip disarticulation, flexible inner socket, external frame

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,318.26 / $1,318.26 / $1,318.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $1,148.15 / $1,819.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,174.90 / $1,174.90 / $1,174.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $851.14 / $851.14
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,621.81 / $4,073.80 / $5,011.87
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,318.26 / $1,621.81 / $2,454.71
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,584.89 / $1,737.80 / $2,344.23
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,698.24 / $2,089.30 / $2,511.89
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,949.84 / $2,137.96 / $2,511.89
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,071.52 / $1,778.28 / $2,570.40
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $1,862.09 / $2,238.72
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,778.28 / $3,019.95 / $8,128.31
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,187.76 / $2,398.83 / $2,398.83
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.31 / $1,258.93 / $4,073.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $933.25 / $1,778.28