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Nebraska rates for HCPCS L6621

Upper Extremity Prosthesis Addition Flexion/Extension Wrist With Or Without Friction For Use With External Powered Terminal Device

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,752.28 / $1,752.28 / $1,752.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,752.28 / $1,752.28 / $2,066.12
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,415.01 / $2,656.51 / $2,683.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,786.24 / $3,022.51 / $3,022.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,786.24 / $3,022.51 / $4,660.79
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,383.41 / $2,978.88 / $12,858.35
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,046.14 / $1,626.18 / $2,284.69
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,013.66 / $3,022.51 / $3,808.28
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,513.17 / $3,572.06 / $6,226.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,046.14 / $1,455.00 / $1,896.34