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Nebraska rates for HCPCS L5706

Custom Shaped Protective Cover Knee Disarticulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$774.33 / $774.33 / $774.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$774.33 / $774.33 / $913.01
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,067.18 / $1,173.90 / $1,185.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$957.73 / $1,335.64 / $1,335.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$957.73 / $1,335.64 / $2,059.58
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.42 / $1,325.89 / $5,705.72
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$462.28 / $727.61 / $1,009.60
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,331.73 / $1,335.64 / $1,682.85
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,110.56 / $1,578.49 / $2,751.62
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$595.23 / $595.23 / $595.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$462.28 / $605.76 / $840.91