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Nebraska rates for HCPCS L5643

Addition to lower extremity, hip disarticulation, flexible inner socket, external frame

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,202.26 / $1,202.26 / $1,202.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,258.93 / $8,128.31
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $1,819.70 / $1,819.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,174.90 / $1,174.90 / $2,089.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $2,454.71 / $3,548.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,202.26 / $2,137.96 / $9,772.37
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $1,148.15 / $1,949.84
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,041.74 / $2,041.74 / $4,677.35
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,089.30 / $2,089.30 / $2,089.30
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,570.40 / $4,677.35 / $4,677.35
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$851.14 / $1,412.54 / $2,137.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $933.25 / $1,445.44