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Nebraska rates for HCPCS L5858

Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, stance phase only, includes electronic sensor(s), any type

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,125.38 / $14,125.38 / $14,125.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11,220.18 / $14,125.38 / $95,499.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19,498.45 / $21,379.62 / $21,877.62
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,454.40 / $14,454.40 / $25,118.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14,454.40 / $26,302.68 / $38,904.51
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,125.38 / $24,547.09 / $104,712.85
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,413.10 / $13,182.57 / $22,387.21
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24,547.09 / $24,547.09 / $56,234.13
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25,118.86 / $25,118.86 / $25,118.86
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30,902.95 / $56,234.13 / $56,234.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,182.57 / $15,135.61 / $22,908.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,317.64 / $11,220.18 / $16,982.44