go back

Iowa rates for HCPCS L5626

Addition to lower extremity, test socket, hip disarticulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $457.09 / $645.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $363.08 / $501.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $489.78 / $660.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $891.25 / $1,096.48
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $758.58 / $812.83
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.11 / $758.58 / $3,090.30
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $426.58 / $1,096.48
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $676.08 / $870.96
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $660.69 / $660.69
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $977.24 / $977.24
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$281.84 / $436.52 / $933.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $316.23 / $562.34
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $575.44 / $575.44