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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
$349.02 / $349.02 / $349.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$349.02 / $421.93 / $3,757.45
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 / $875.29 / $901.55
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$545.64 / $880.07 / $1,144.09
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,055.60 / $1,177.28 / $1,177.28
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$670.38 / $843.87 / $1,265.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$488.14 / $540.63 / $775.60