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Iowa rates for HCPCS L5595

Preparatory, hip disarticulation/hemipelvectomy, pylon, no cover, SACH foot, thermoplastic or equal, molded to patient model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,516.07 / $4,632.92 / $4,632.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,123.39 / $2,902.58 / $4,463.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,578.08 / $3,578.08 / $5,316.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,171.21 / $6,412.50 / $8,015.63
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,687.17 / $5,650.98 / $10,113.42
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,081.93 / $6,371.33 / $25,854.57
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,389.51 / $3,214.69 / $6,602.97
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,300.49 / $5,316.05 / $7,341.72
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,353.88 / $6,282.60 / $10,158.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,389.51 / $2,744.76 / $6,333.74
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,736.10 / $4,736.10 / $4,736.10
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,741.53 / $4,736.10 / $4,736.10