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Nebraska rates for HCPCS L5624

Addition to lower extremity, test socket, above knee (AK)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$278.27 / $278.27 / $278.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$278.27 / $278.27 / $328.11
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$383.51 / $421.87 / $426.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$311.77 / $480.00 / $480.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$311.77 / $480.00 / $740.15
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$241.47 / $478.58 / $2,310.33
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.13 / $287.66 / $460.78
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$478.58 / $480.00 / $662.90
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$434.59 / $575.28 / $988.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.13 / $217.69 / $335.46