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Iowa rates for HCPCS L5639

Addition To Lower Extremity Below Knee Wood Socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,127.14 / $1,127.14 / $1,305.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$560.58 / $808.22 / $1,131.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$870.50 / $870.50 / $1,480.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.50 / $1,560.00 / $1,950.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,305.14 / $2,871.93 / $3,447.48
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$858.16 / $1,774.09 / $7,424.54
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$665.36 / $895.13 / $1,838.59
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,475.92 / $1,480.25 / $2,044.29
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,339.00 / $1,729.13 / $2,828.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$665.36 / $775.90 / $1,583.39
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,318.77 / $1,318.77 / $1,318.77
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,041.83 / $1,318.77 / $1,318.77