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Nebraska rates for HCPCS L5210

Above knee (AK), short prosthesis, no knee joint (stubbies), with foot blocks, no ankle joints, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,993.73 / $1,993.73 / $1,993.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,993.73 / $1,993.73 / $2,350.82
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,747.78 / $3,022.55 / $3,053.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,819.89 / $3,439.00 / $3,439.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.89 / $3,439.00 / $5,303.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,745.63 / $3,422.08 / $15,534.23
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,190.29 / $1,933.89 / $2,599.51
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,428.93 / $3,439.00 / $4,424.51
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,093.00 / $4,064.27 / $7,084.88
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,776.27 / $1,776.27 / $1,776.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,190.29 / $1,559.71 / $2,239.04