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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
$373.19 / $373.19 / $373.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$373.19 / $373.19 / $440.03
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$514.33 / $565.76 / $571.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$493.58 / $643.72 / $643.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$493.58 / $643.72 / $1,105.78
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$335.87 / $641.83 / $3,080.66
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$222.80 / $373.82 / $486.58
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$641.83 / $643.72 / $869.35
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$582.84 / $771.50 / $1,326.16
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$648.55 / $648.55 / $648.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$222.80 / $356.02 / $439.93