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Texas rates for HCPCS L5722

Addition, exoskeletal knee-shin system, single axis, pneumatic swing, friction stance phase control

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$478.19 / $478.19 / $516.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.19 / $516.45 / $956.38
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,092.22 / $1,092.22 / $1,092.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$875.29 / $875.29 / $875.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$638.96 / $638.96 / $875.29
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,634.02 / $6,185.97 / $6,185.97
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,301.80 / $6,301.80 / $8,127.53
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$349.02 / $781.71 / $1,092.22
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$352.96 / $987.94 / $1,273.08
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$349.02 / $781.71 / $1,092.22
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$638.96 / $638.96 / $901.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$450.53 / $666.47 / $820.27
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.74 / $659.00 / $1,092.22