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Oregon rates for HCPCS L5673

Addition To Lower Extremity Below Knee/Above Kneecustom Fabricated From Existing Mold Or Prefabricated Socket Insert Silicone Gel Elastomeric Or Equal For Use With Locking Mechanism

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$369.74 / $522.90 / $2,713.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.15 / $501.15 / $501.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$365.84 / $365.84 / $501.15
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$601.83 / $1,698.84 / $2,215.69
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$522.90 / $716.37 / $859.76
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$639.26 / $808.17 / $902.75
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$682.45 / $859.76 / $945.74
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$773.78 / $859.76 / $909.40
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.15 / $747.75 / $902.75
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$365.84 / $752.83 / $945.74
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$716.30 / $1,429.74 / $3,016.29
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$739.39 / $945.74 / $945.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$382.28 / $400.12 / $763.37