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Nebraska rates for HCPCS L5668

Addition to lower extremity, below knee (BK), molded distal cushion

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.62 / $77.62 / $77.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $77.62 / $707.95
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.15 / $117.49 / $120.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.13 / $89.13 / $138.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $158.49 / $234.42
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.62 / $138.04 / $645.65
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.74 / $75.86 / $128.82
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $134.90 / $309.03
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.04 / $138.04 / $138.04
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $309.03 / $309.03
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.43 / $91.20 / $141.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.77 / $61.66 / $95.50