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Nebraska rates for HCPCS L5642

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $489.78 / $489.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $489.78 / $3,235.94
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $741.31 / $741.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$524.81 / $524.81 / $851.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $954.99 / $1,412.54
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $851.14 / $3,890.45
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $467.74 / $758.58
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,047.13 / $1,905.46
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$851.14 / $851.14 / $851.14
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,412.54 / $1,905.46
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$338.84 / $562.34 / $851.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $380.19 / $602.56