go back

Nebraska rates for HCPCS L5685

Addition to lower extremity prosthesis, below knee, suspension/sealing sleeve, with or without valve, any material, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$98.13 / $98.13 / $98.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.13 / $98.13 / $115.71
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.42 / $115.42 / $115.42
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$135.25 / $148.78 / $150.28
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.03 / $169.28 / $169.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.03 / $169.28 / $261.02
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.47 / $166.82 / $720.06
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.59 / $98.30 / $151.03
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$168.78 / $169.28 / $213.26
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.00 / $200.06 / $348.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.59 / $83.06 / $106.19