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Oregon rates for HCPCS L5695

Addition to lower extremity, above knee (AK), pelvic control, sleeve suspension, neoprene or equal, each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.08 / $119.05 / $752.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$122.31 / $122.31 / $122.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.29 / $89.29 / $122.31
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.01 / $414.77 / $540.96
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$119.05 / $163.94 / $201.22
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$145.54 / $183.99 / $205.52
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$155.38 / $195.73 / $237.97
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$155.38 / $195.73 / $237.97
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.68 / $171.39 / $205.52
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.29 / $171.39 / $215.30
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$163.08 / $325.50 / $686.69
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$168.33 / $215.30 / $215.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.30 / $97.65 / $186.30