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Nebraska rates for HCPCS L7404

Addition To Upper Extremity Prosthesis Above Elbow Disarticulation Acrylic Material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$425.79 / $425.79 / $425.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$425.79 / $425.79 / $502.05
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$586.83 / $645.50 / $652.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$434.07 / $734.45 / $734.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$434.07 / $734.45 / $1,132.55
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$336.18 / $723.84 / $3,124.60
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$254.20 / $395.17 / $555.16
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$732.30 / $734.45 / $925.39
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$610.69 / $867.98 / $1,513.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$254.20 / $333.10 / $460.81