go back

Montana 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
$1,083.33 / $3,757.45 / $3,757.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$875.29 / $1,265.81 / $1,265.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$875.29 / $1,029.38 / $1,265.81
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$604.16 / $1,205.53 / $1,265.81
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$875.29 / $950.05 / $1,266.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$488.63 / $540.63 / $833.09