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Nebraska rates for HCPCS L5696

Addition To Lower Extremity Above Knee Or Knee Disarticulation Pelvic Joint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$151.16 / $151.16 / $151.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.16 / $151.16 / $178.24
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.34 / $229.18 / $231.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.76 / $260.76 / $260.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.76 / $260.76 / $402.08
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$118.76 / $259.45 / $1,184.51
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.25 / $146.63 / $197.10
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$259.98 / $260.76 / $337.36
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$236.00 / $308.17 / $537.19
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$251.68 / $251.68 / $251.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.25 / $132.09 / $170.72