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Nebraska rates for HCPCS L5697

Addition to lower extremity, above knee (AK) or knee disarticulation, pelvic band

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.45 / $61.45 / $61.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.45 / $61.45 / $72.45
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.68 / $93.15 / $94.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.21 / $105.99 / $105.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.21 / $105.99 / $163.41
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.31 / $105.47 / $510.07
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.68 / $61.55 / $80.11
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$105.68 / $105.99 / $146.36
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.96 / $126.36 / $218.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.68 / $48.07 / $74.06