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Nebraska rates for HCPCS L5614

Addition to lower extremity, exoskeletal system, above knee (AK), knee disarticulation, four-bar linkage, with pneumatic swing phase control

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,292.73 / $1,292.73 / $1,292.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,292.73 / $1,292.73 / $1,524.27
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,781.66 / $1,959.81 / $1,979.61
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,317.79 / $2,229.84 / $2,229.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,317.79 / $2,229.84 / $3,438.46
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,020.61 / $2,205.60 / $9,502.08
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$771.78 / $1,210.52 / $1,685.52
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,223.32 / $2,229.84 / $2,809.52
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,854.07 / $2,635.27 / $4,593.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$771.78 / $1,082.45 / $1,399.02