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Iowa rates for HCPCS L5650

Additions to lower extremity, total contact, above knee (AK) or knee disarticulation socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$490.78 / $490.78 / $568.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$244.09 / $351.91 / $492.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$379.03 / $379.03 / $644.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$547.98 / $679.13 / $848.91
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$568.29 / $637.96 / $765.82
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$373.67 / $772.48 / $3,128.86
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$289.70 / $389.76 / $800.57
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$642.65 / $644.53 / $890.13
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$572.00 / $752.91 / $1,231.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$289.70 / $347.72 / $761.72
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$574.22 / $574.22 / $574.22
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$453.63 / $574.22 / $574.22