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Nebraska rates for HCPCS L5781

Addition To Lower Limb Prosthesis Vacuum Pump Residual Limb Volume Management And Moisture Evacuation System

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,065.21 / $3,065.21 / $3,065.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,065.21 / $3,065.21 / $3,614.20
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,224.50 / $4,646.93 / $4,693.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,886.72 / $5,287.19 / $5,287.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,886.72 / $5,287.19 / $8,152.98
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,420.00 / $5,210.85 / $22,493.11
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,829.98 / $2,870.29 / $4,717.08
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,271.72 / $5,287.19 / $6,661.69
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,719.00 / $6,248.50 / $10,892.50
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,890.35 / $4,890.35 / $4,890.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,829.98 / $2,397.94 / $3,317.27