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Nebraska rates for HCPCS L5705

Custom shaped protective cover, above knee (AK)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$781.25 / $781.25 / $781.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$781.25 / $781.25 / $921.17
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,076.72 / $1,184.40 / $1,196.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$895.43 / $1,347.58 / $1,347.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$895.43 / $1,347.58 / $2,077.98
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$693.49 / $1,340.95 / $5,814.95
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$466.42 / $741.64 / $1,018.62
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,343.63 / $1,347.58 / $1,697.88
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,120.48 / $1,592.59 / $2,776.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$466.42 / $663.17 / $857.13