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Nebraska rates for HCPCS L6695

Addition To Upper Extremity Prosthesis Below Elbow/Above Elbow Custom

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$477.82 / $477.82 / $477.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$477.82 / $477.82 / $563.40
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$658.52 / $724.38 / $731.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$564.36 / $824.19 / $824.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$564.36 / $824.19 / $1,270.90
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$396.13 / $812.29 / $3,490.81
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$285.26 / $440.60 / $622.99
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.78 / $824.19 / $1,038.43
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$685.29 / $974.04 / $1,697.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$285.26 / $373.79 / $513.79