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Nebraska rates for HCPCS L5658

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$338.84 / $338.84 / $338.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $338.84 / $1,949.84
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $512.86 / $512.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$363.08 / $363.08 / $588.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $630.96 / $891.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$338.84 / $575.44 / $2,344.23
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $288.40 / $524.81
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $575.44 / $1,318.26
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$588.84 / $588.84 / $588.84
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $1,318.26 / $1,318.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.98 / $331.13 / $501.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $263.03 / $398.11