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Iowa rates for HCPCS L5626

Addition To Lower Extremity Test Socket Hip Disarticulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.34 / $639.09 / $639.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$238.39 / $372.57 / $501.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$493.58 / $493.58 / $643.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$493.58 / $884.63 / $1,105.78
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$567.58 / $760.44 / $805.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$373.19 / $760.89 / $3,080.66
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$285.49 / $380.66 / $799.55
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$641.83 / $643.72 / $869.35
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$527.22 / $760.76 / $1,230.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$915.61 / $915.61 / $1,487.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$285.49 / $332.38 / $763.01
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$573.50 / $573.50 / $573.50
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$453.07 / $573.50 / $573.50