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Iowa rates for HCPCS L2795

Addition to lower extremity orthosis, knee control, full kneecap

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$68.66 / $68.66 / $69.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.65 / $57.49 / $85.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.69 / $62.81 / $105.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.81 / $114.38 / $142.97
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.94 / $99.68 / $108.03
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.14 / $123.01 / $501.46
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.76 / $53.96 / $130.80
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$105.00 / $105.30 / $145.41
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.23 / $123.04 / $201.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.76 / $47.76 / $112.71
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.82 / $93.82 / $93.82
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.12 / $93.82 / $93.82