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Nebraska rates for HCPCS L5722

Addition Exoskeletal Knee-Shin System Single Axis Pneumatic Swing Friction Stance Phase Control

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$826.06 / $826.06 / $826.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$826.06 / $826.06 / $974.01
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,138.49 / $1,252.33 / $1,264.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$875.29 / $1,424.89 / $1,424.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$875.29 / $1,424.89 / $2,197.19
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$677.90 / $1,404.30 / $5,634.02
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$493.17 / $720.84 / $1,077.06
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,420.71 / $1,424.89 / $1,795.31
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,166.99 / $1,664.46 / $2,935.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$488.14 / $646.24 / $1,013.84