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Nebraska rates for HCPCS L5650

Additions to lower extremity, total contact, above knee (AK) or knee disarticulation socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$373.67 / $373.67 / $373.67
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$373.67 / $373.67 / $440.59
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$514.99 / $566.49 / $572.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$379.03 / $644.53 / $644.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$626.98 / $679.13 / $993.89
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$336.30 / $641.37 / $3,128.86
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.08 / $389.76 / $572.21
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$642.65 / $644.53 / $890.13
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$572.00 / $761.72 / $1,327.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.08 / $356.46 / $450.45