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Nebraska rates for HCPCS L5658

Addition To Lower Extremity Socket Insert Above Knee (Kemblo Pelite Aliplast Plastazote Or Equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$335.08 / $335.08 / $335.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$335.08 / $335.08 / $395.09
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$461.81 / $507.99 / $513.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$366.26 / $577.97 / $577.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$366.26 / $577.97 / $891.26
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$274.55 / $569.64 / $2,323.85
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$200.05 / $290.29 / $436.89
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$576.29 / $577.97 / $728.23
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$473.36 / $675.16 / $1,190.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$196.58 / $262.13 / $335.50