go back

Iowa rates for HCPCS L5624

Addition to lower extremity, test socket, above knee (AK)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$318.45 / $403.69 / $403.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.77 / $262.08 / $382.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$311.77 / $311.77 / $480.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$311.77 / $558.75 / $698.44
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$423.21 / $492.09 / $602.98
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$278.27 / $575.55 / $2,310.33
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$215.75 / $290.26 / $596.19
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$478.58 / $480.00 / $662.90
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$393.12 / $567.27 / $917.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$215.75 / $247.83 / $571.88
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$427.63 / $427.63 / $427.63
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$337.83 / $427.63 / $427.63