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Nebraska rates for HCPCS L5655

Addition to lower extremity, socket insert, below knee (BK) (Kemblo, Pelite, Aliplast, Plastazote or equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$203.02 / $203.02 / $203.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$203.02 / $203.02 / $239.38
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$279.80 / $307.77 / $310.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$221.07 / $350.19 / $350.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$221.07 / $350.19 / $540.01
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$171.21 / $348.46 / $1,741.43
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$121.20 / $203.36 / $264.70
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$349.16 / $350.19 / $483.63
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$291.18 / $419.70 / $721.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$121.20 / $189.36 / $244.74