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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
$14,237.72 / $14,237.72 / $14,237.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14,237.72 / $14,237.72 / $16,787.75
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19,622.56 / $21,584.81 / $21,802.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,513.81 / $24,558.72 / $24,558.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14,513.81 / $24,558.72 / $37,870.05
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,240.68 / $24,204.12 / $104,478.94
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,500.12 / $13,213.37 / $18,563.75
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24,486.86 / $24,558.72 / $30,943.14
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20,113.72 / $29,023.94 / $50,594.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,500.12 / $13,213.37 / $15,408.48