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Nebraska rates for HCPCS L5698

Addition to lower extremity, above knee (AK) or knee disarticulation, Silesian bandage

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$88.76 / $88.76 / $88.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.76 / $88.76 / $104.66
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.33 / $134.56 / $135.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.25 / $153.10 / $153.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$148.94 / $166.88 / $236.11
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.16 / $151.88 / $682.16
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.99 / $83.28 / $115.74
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$152.66 / $153.10 / $192.92
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.63 / $180.93 / $315.45
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.16 / $47.16 / $82.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.99 / $82.54 / $96.25