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Nebraska rates for HCPCS L5699

All lower extremity prostheses, shoulder harness

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$142.72 / $142.72 / $142.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.72 / $142.72 / $168.28
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$196.69 / $216.34 / $218.53
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.96 / $246.17 / $246.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.46 / $285.38 / $379.60
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$123.34 / $244.96 / $1,197.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.20 / $142.94 / $186.08
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.45 / $246.17 / $339.98
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$222.89 / $295.02 / $507.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.20 / $133.11 / $172.04