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Nebraska rates for HCPCS L5301

Below knee (BK), molded socket, shin, SACH foot, endoskeletal system

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,991.31 / $1,991.31 / $1,991.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,991.31 / $1,991.31 / $2,347.96
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,341.91 / $2,341.91 / $2,341.91
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,744.42 / $3,018.88 / $3,049.36
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,721.98 / $3,434.81 / $3,434.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,721.98 / $3,434.81 / $5,296.55
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,620.42 / $3,385.23 / $14,785.52
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,188.83 / $1,848.22 / $3,122.55
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,424.76 / $3,434.81 / $4,327.75
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,109.96 / $4,059.32 / $7,076.27
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,123.22 / $3,123.22 / $3,123.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,188.83 / $1,557.81 / $2,118.58