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Nebraska rates for HCPCS L5622

Addition to lower extremity, test socket, knee disarticulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$279.14 / $279.14 / $279.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$279.14 / $279.14 / $329.14
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$384.70 / $423.19 / $427.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$274.54 / $481.49 / $481.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$468.37 / $559.13 / $742.46
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$241.55 / $480.08 / $2,359.33
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.65 / $286.86 / $462.22
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$480.08 / $481.49 / $661.02
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$400.35 / $577.07 / $991.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.65 / $218.37 / $334.51