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Nebraska rates for HCPCS L5647

Addition To Lower Extremity Below Knee Suction Socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$811.81 / $811.81 / $811.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$811.81 / $811.81 / $957.21
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.75 / $954.75 / $954.75
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,118.83 / $1,230.73 / $1,243.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$596.58 / $1,400.30 / $1,400.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,107.00 / $1,400.30 / $2,159.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$637.77 / $1,380.08 / $5,050.38
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$484.66 / $665.36 / $1,058.47
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,396.20 / $1,400.30 / $1,764.30
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,127.98 / $1,635.74 / $2,768.14
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$359.65 / $629.41 / $733.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$460.43 / $635.08 / $787.44