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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
$61.66 / $61.66 / $61.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $61.66 / $562.34
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $93.33 / $93.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.26 / $60.26 / $107.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $125.89 / $186.21
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.66 / $109.65 / $512.86
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $60.26 / $100.00
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $107.15 / $239.88
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.15 / $107.15 / $107.15
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $239.88 / $239.88
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.10 / $72.44 / $112.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.31 / $47.86 / $74.13