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Nebraska rates for HCPCS L6638

Upper extremity addition to prosthesis, electric locking feature, only for use with manually powered elbow

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,915.78 / $1,915.78 / $1,915.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,915.78 / $1,915.78 / $2,258.91
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,640.34 / $2,904.38 / $2,933.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,952.91 / $3,304.54 / $3,304.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,952.91 / $3,304.54 / $5,095.64
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,512.49 / $3,256.83 / $14,058.21
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,143.75 / $1,777.93 / $2,497.87
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,294.88 / $3,304.54 / $4,163.62
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,949.00 / $3,905.37 / $6,807.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,143.75 / $1,498.72 / $2,073.29