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Nebraska rates for HCPCS L5694

Addition to lower extremity, above knee (AK), pelvic control belt, padded and lined

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.86 / $138.86 / $138.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.86 / $138.86 / $163.72
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.38 / $210.50 / $212.63
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.85 / $239.51 / $239.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$233.00 / $252.38 / $369.34
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$124.97 / $238.34 / $1,167.33
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.90 / $139.09 / $181.05
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$238.83 / $239.51 / $330.78
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.00 / $283.06 / $493.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.90 / $132.46 / $167.39