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Oregon rates for HCPCS L6697

Addition To Upper Extremity Prosthesis Below Elbow/Above Elbow Custom

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.69 / $942.63 / $4,471.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,111.22 / $1,111.22 / $1,111.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$811.19 / $811.19 / $811.19
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,084.93 / $3,005.63 / $3,920.10
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$942.63 / $1,321.14 / $1,549.90
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,152.40 / $1,456.91 / $1,627.40
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,394.91 / $1,549.90 / $1,769.46
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,231.25 / $1,231.25 / $1,231.25
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$942.63 / $1,357.14 / $1,627.40
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$811.19 / $1,357.14 / $1,704.89
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,291.28 / $2,577.40 / $5,437.52
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,332.91 / $1,704.89 / $1,704.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.33 / $707.89 / $1,350.55