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Iowa rates for HCPCS L5220

Above knee (AK), short prosthesis, no knee joint (stubbies), with articulated ankle/foot, dynamically aligned, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,630.27 / $2,884.03 / $3,235.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $1,905.46 / $2,884.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,454.71 / $2,454.71 / $4,073.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,454.71 / $4,466.84 / $5,623.41
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,235.94 / $3,801.89 / $4,265.80
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,511.89 / $4,677.35 / $17,782.79
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $2,511.89 / $6,165.95
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,981.07 / $4,168.69 / $5,011.87
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,073.80 / $4,073.80 / $4,073.80
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,801.89 / $6,165.95 / $6,165.95
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,621.81 / $2,570.40 / $5,370.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $1,905.46 / $3,388.44
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,818.38 / $3,548.13 / $3,548.13