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Oregon rates for HCPCS L6695

Addition To Upper Extremity Prosthesis Below Elbow/Above Elbow Custom

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$308.10 / $435.74 / $2,261.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$564.36 / $564.36 / $564.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$411.98 / $411.98 / $564.36
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.51 / $1,415.46 / $1,846.12
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$435.74 / $610.72 / $716.44
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$532.71 / $673.45 / $752.26
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$644.79 / $716.44 / $833.57
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$435.74 / $627.34 / $752.26
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$411.98 / $627.34 / $788.08
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$596.90 / $1,191.42 / $2,513.50
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.14 / $788.08 / $788.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$318.56 / $333.42 / $652.66