go back

Nebraska rates for HCPCS L5654

Addition to lower extremity, socket insert, Symes, (Kemblo, Pelite, Aliplast, Plastazote or equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$271.33 / $271.33 / $271.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$271.33 / $271.33 / $319.93
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$373.95 / $411.35 / $415.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$306.16 / $468.03 / $468.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$306.16 / $468.03 / $721.71
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$237.12 / $465.73 / $2,089.06
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.99 / $263.18 / $353.78
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$466.66 / $468.03 / $604.69
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.00 / $553.12 / $964.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.99 / $262.42 / $306.01