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Nebraska rates for HCPCS L6629

Upper extremity addition, quick disconnect lamination collar with coupling piece, Otto Bock or equal

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$114.82 / $114.82 / $114.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $114.82 / $912.01
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.49 / $173.78 / $177.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.20 / $112.20 / $204.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $239.88 / $338.84
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$114.82 / $204.17 / $912.01
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $112.20 / $181.97
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.53 / $251.19 / $457.09
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$204.17 / $204.17 / $204.17
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $338.84 / $457.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.43 / $131.83 / $204.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.18 / $91.20 / $141.25