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Nebraska rates for HCPCS L5795

Addition, exoskeletal system, hip disarticulation, ultra-light material (titanium, carbon fiber or equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.82 / $821.82 / $821.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$821.82 / $821.82 / $969.01
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,132.63 / $1,245.90 / $1,258.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$908.11 / $1,417.56 / $1,417.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,378.93 / $1,494.00 / $2,185.90
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$739.64 / $1,410.58 / $6,807.72
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$490.64 / $823.19 / $1,071.52
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,413.40 / $1,417.56 / $1,957.71
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,259.00 / $1,675.30 / $2,920.39
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,460.51 / $1,460.51 / $1,460.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$490.64 / $642.91 / $990.71