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Nebraska rates for HCPCS L3265

Plastazote sandal, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.28 / $8.28 / $8.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.28 / $8.28 / $12.92
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.81 / $11.89 / $12.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.65 / $28.65 / $28.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.64 / $22.75 / $28.65
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.62 / $14.51 / $90.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.25 / $7.95 / $13.62
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.29 / $21.26 / $33.47
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.21 / $23.62 / $35.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.25 / $7.87 / $13.16