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Nebraska rates for HCPCS L5701

Replacement, socket, above knee (AK)/knee disarticulation, including attachment plate, molded to patient model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,034.91 / $3,034.91 / $3,034.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,034.91 / $3,034.91 / $3,578.48
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,182.72 / $4,601.02 / $4,647.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,550.04 / $5,234.93 / $5,234.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,550.04 / $5,234.93 / $8,072.40
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,384.30 / $5,159.35 / $21,140.73
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,811.89 / $2,844.05 / $4,486.14
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,219.62 / $5,234.93 / $6,595.86
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,287.43 / $6,186.74 / $10,784.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,625.10 / $4,625.10 / $4,625.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,811.89 / $2,374.23 / $3,137.34