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Nebraska rates for HCPCS L5976

All lower extremity prostheses, energy storing foot (Seattle Carbon Copy II or equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$482.84 / $482.84 / $482.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$482.84 / $482.84 / $569.30
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$665.45 / $732.00 / $739.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$420.01 / $832.85 / $832.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$420.01 / $832.85 / $1,284.26
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$379.32 / $820.83 / $3,565.60
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.26 / $447.11 / $629.54
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$830.41 / $832.85 / $1,049.33
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$712.00 / $984.28 / $1,715.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.26 / $377.72 / $516.74