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Idaho rates for HCPCS L5822

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,243.08 / $1,718.11 / $1,718.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,281.95 / $1,367.82 / $1,367.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$998.51 / $1,367.82 / $1,458.16
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$658.29 / $1,439.73 / $2,043.89
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,839.50 / $1,941.70 / $2,043.89
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $1,508.39 / $1,796.39
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,789.70 / $1,995.99 / $2,993.99
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,430.72 / $1,492.04 / $2,146.08
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.63 / $1.63 / $1,529.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$942.77 / $1,019.68 / $1,583.86