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Utah 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
$346.74 / $346.74 / $346.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $602.56 / $5,623.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$870.96 / $870.96 / $870.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $645.65 / $891.25
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $870.96 / $1,148.15
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $1,047.13 / $1,819.70
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $851.14 / $1,288.25
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,202.26 / $1,288.25
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,230.27 / $1,548.82
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $645.65 / $812.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.58 / $537.03 / $812.83