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Oregon rates for HCPCS L5658

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$189.07 / $353.89 / $1,303.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$366.26 / $366.26 / $366.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$267.37 / $267.37 / $366.26
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.31 / $924.71 / $1,206.04
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$353.89 / $458.99 / $581.87
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$432.65 / $546.96 / $581.87
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$461.88 / $523.67 / $581.87
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$500.21 / $581.87 / $581.87
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$329.46 / $496.00 / $610.96
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$267.37 / $509.51 / $640.05
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$484.78 / $967.62 / $2,041.40
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$500.41 / $640.05 / $640.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.01 / $217.72 / $415.37