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Oregon rates for HCPCS L5699

All lower extremity prostheses, shoulder harness

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.90 / $179.44 / $860.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.96 / $169.96 / $169.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.07 / $124.07 / $169.96
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$206.54 / $473.71 / $617.83
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$167.84 / $229.43 / $295.05
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$219.37 / $277.35 / $309.80
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.54 / $246.17 / $295.05
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.79 / $295.05 / $295.05
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$148.01 / $246.18 / $309.80
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.07 / $258.35 / $324.56
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.81 / $490.64 / $1,035.10
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$253.74 / $324.56 / $324.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.67 / $111.65 / $213.01