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Oregon rates for HCPCS L5685

Addition to lower extremity prosthesis, below knee, suspension/sealing sleeve, with or without valve, any material, each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.34 / $91.79 / $435.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.03 / $100.03 / $100.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.02 / $73.02 / $100.03
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.64 / $292.60 / $381.62
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.79 / $125.75 / $150.91
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.21 / $141.86 / $158.47
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$119.79 / $150.91 / $166.01
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.79 / $150.91 / $156.33
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.79 / $131.26 / $158.47
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.02 / $132.15 / $166.01
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.74 / $250.98 / $529.47
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.79 / $166.01 / $166.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.84 / $68.92 / $131.47