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Nebraska rates for HCPCS L5626

Addition to lower extremity, test socket, hip disarticulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$371.54 / $371.54 / $371.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $371.54 / $2,818.38
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $562.34 / $575.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $489.78 / $660.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $776.25 / $1,096.48
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$371.54 / $645.65 / $3,090.30
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.98 / $363.08 / $616.60
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $645.65 / $1,479.11
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $660.69 / $660.69
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $1,479.11 / $1,479.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.00 / $426.58 / $660.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $295.12 / $436.52