go back

Nebraska rates for HCPCS L5975

All lower extremity prostheses, combination single axis ankle and flexible keel foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$355.13 / $355.13 / $355.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$355.13 / $355.13 / $418.74
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.44 / $538.38 / $543.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$362.03 / $612.57 / $612.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$362.03 / $612.57 / $944.60
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$280.39 / $605.98 / $2,615.79
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.02 / $329.60 / $463.04
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$610.79 / $612.57 / $771.81
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$509.34 / $723.94 / $1,262.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.02 / $277.82 / $384.36