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Nebraska rates for HCPCS L5220

Above knee (AK), short prosthesis, no knee joint (stubbies), with articulated ankle/foot, dynamically aligned, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,333.98 / $2,333.98 / $2,333.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,333.98 / $2,333.98 / $2,752.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,216.71 / $3,538.38 / $3,574.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,482.86 / $4,025.89 / $4,025.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,482.86 / $4,025.89 / $6,208.01
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,922.93 / $4,006.08 / $17,674.86
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,393.42 / $2,202.14 / $3,043.14
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,014.12 / $4,025.89 / $5,072.49
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,347.45 / $4,757.87 / $8,294.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,247.08 / $2,182.50 / $2,545.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,376.34 / $1,825.88 / $2,545.08