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Nebraska rates for HCPCS L5677

Additions To Lower Extremity Below Knee Knee Joints Polycentric Pair

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$405.97 / $405.97 / $405.97
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$405.97 / $405.97 / $478.68
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$559.50 / $615.45 / $621.66
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$400.78 / $700.25 / $700.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$400.78 / $700.25 / $1,079.79
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$333.73 / $696.81 / $3,128.35
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$242.37 / $393.65 / $529.30
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$698.20 / $700.25 / $899.01
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$582.24 / $827.57 / $1,442.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$242.37 / $352.00 / $498.24