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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
$2,631.71 / $3,214.82 / $3,214.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,379.09 / $1,988.34 / $2,898.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,482.86 / $2,482.86 / $4,025.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,482.86 / $4,449.75 / $5,562.19
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,310.57 / $3,838.15 / $4,298.29
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,333.98 / $4,757.87 / $17,674.86
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,749.67 / $2,307.14 / $5,000.49
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,014.12 / $4,025.89 / $5,029.24
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,297.23 / $4,702.79 / $7,693.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,364.07 / $2,182.50 / $2,488.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,744.48 / $1,908.81 / $4,306.35
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,586.70 / $3,586.70 / $3,586.70
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,833.49 / $3,586.70 / $3,586.70