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Idaho rates for HCPCS L5722

Addition Exoskeletal Knee-Shin System Single Axis Pneumatic Swing Friction Stance Phase Control

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$774.29 / $1,070.17 / $1,083.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$816.83 / $875.29 / $875.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$638.96 / $875.29 / $901.55
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$349.02 / $955.77 / $1,273.08
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,145.78 / $1,209.44 / $1,273.08
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $939.53 / $1,118.93
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,114.76 / $1,243.25 / $1,864.88
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.16 / $891.16 / $1,336.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$499.85 / $540.63 / $857.43