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Nebraska rates for HCPCS L5859

Addition to lower extremity prosthesis, endoskeletal knee-shin system, powered and programmable flexion/extension assist control, includes any type motor(s)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,220.18 / $11,220.18 / $11,220.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,912.51 / $11,220.18 / $74,131.02
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,488.17 / $16,982.44 / $16,982.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,772.37 / $9,772.37 / $19,498.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,772.37 / $20,417.38 / $30,199.52
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,220.18 / $19,498.45 / $81,283.05
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,456.54 / $10,471.29 / $14,454.40
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19,054.61 / $23,988.33 / $43,651.58
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19,498.45 / $19,498.45 / $19,498.45
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23,988.33 / $30,199.52 / $43,651.58
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,471.29 / $12,302.69 / $18,197.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,456.54 / $8,709.64 / $13,489.63