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Nebraska rates for HCPCS L5971

All lower extremity prostheses, solid ankle cushion heel (SACH) foot, replacement only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$160.49 / $160.49 / $160.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.49 / $160.49 / $189.24
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$221.19 / $243.31 / $245.77
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$159.21 / $276.83 / $276.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$159.21 / $276.83 / $426.89
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$131.38 / $275.47 / $1,295.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.82 / $160.69 / $209.26
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$276.02 / $276.83 / $370.31
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$250.65 / $331.79 / $570.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.82 / $125.56 / $187.40