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Nebraska rates for HCPCS L5855

Addition Endoskeletal System Hip Disarticulation Mechanical Hip Extension Assist

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$315.18 / $315.18 / $315.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$315.18 / $315.18 / $371.63
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$434.38 / $477.81 / $482.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.78 / $543.65 / $543.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.78 / $537.19 / $838.32
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$247.61 / $535.80 / $1,982.96
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$184.93 / $246.57 / $410.94
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$542.05 / $543.65 / $684.99
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$437.93 / $635.07 / $1,074.72
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$247.02 / $247.02 / $247.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$178.76 / $246.56 / $315.70