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Oregon rates for HCPCS L5697

Addition to lower extremity, above knee (AK) or knee disarticulation, pelvic band

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.75 / $78.13 / $370.67
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.21 / $60.21 / $60.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.95 / $43.95 / $60.21
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.93 / $203.82 / $265.86
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.26 / $98.75 / $128.47
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.52 / $120.76 / $134.88
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$101.98 / $115.49 / $128.47
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.99 / $128.47 / $128.47
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.37 / $109.51 / $134.88
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.95 / $112.49 / $141.32
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.03 / $213.64 / $450.70
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.48 / $141.32 / $141.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.74 / $48.07 / $91.71