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Oregon rates for HCPCS L5655

Addition To Lower Extremity Socket Insert Below Knee (Kemblo Pelite Aliplast Plastazote Or Equal)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$146.13 / $253.41 / $1,224.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$221.07 / $221.07 / $221.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.38 / $161.38 / $221.07
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$291.66 / $673.99 / $879.07
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$238.76 / $326.70 / $416.66
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.80 / $391.66 / $437.49
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$310.89 / $354.16 / $416.66
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$318.35 / $416.66 / $416.66
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$208.75 / $347.17 / $437.49
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.38 / $364.84 / $458.33
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$347.14 / $692.90 / $1,461.77
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$358.33 / $458.33 / $458.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.74 / $158.83 / $303.01