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Nebraska rates for HCPCS L5628

Addition To Lower Extremity Test Socket Hemipelvectomy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$387.34 / $387.34 / $387.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$387.34 / $387.34 / $456.71
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$533.84 / $587.22 / $593.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$499.82 / $668.13 / $668.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$499.82 / $668.13 / $1,119.83
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$348.61 / $664.84 / $3,076.44
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$231.25 / $382.03 / $505.03
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$666.17 / $668.13 / $880.34
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$604.95 / $800.75 / $1,376.46
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.30 / $218.30 / $382.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$219.69 / $303.02 / $445.50