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Nebraska rates for HCPCS L5200

Above knee (AK), molded socket, single axis constant friction knee, shin, SACH foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,699.73 / $2,699.73 / $2,699.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,699.73 / $2,699.73 / $3,183.27
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,720.80 / $4,092.88 / $4,134.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,728.17 / $4,656.78 / $4,656.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,529.91 / $5,087.25 / $7,180.86
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,198.52 / $4,633.87 / $20,802.65
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,611.78 / $2,618.69 / $3,520.03
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,643.16 / $4,656.78 / $6,023.40
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,872.03 / $5,503.47 / $9,593.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,611.78 / $2,112.02 / $3,048.16