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Nebraska rates for HCPCS L6696

Addition To Upper Extremity Prosthesis Below Elbow/Above Elbow Custom

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,007.69 / $1,007.69 / $1,007.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,007.69 / $1,007.69 / $1,188.17
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,388.80 / $1,527.68 / $1,543.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$886.63 / $1,738.15 / $1,738.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$886.63 / $1,738.15 / $2,680.27
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$795.58 / $1,713.07 / $7,396.37
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$601.60 / $935.43 / $1,313.86
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,733.08 / $1,738.15 / $2,190.02
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,551.00 / $2,054.17 / $3,580.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$601.60 / $853.27 / $1,090.83