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Iowa rates for HCPCS L5655

Addition to lower extremity, socket insert, below knee (BK) (Kemblo, Pelite, Aliplast, Plastazote or equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$231.62 / $286.23 / $286.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.52 / $191.21 / $286.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$221.07 / $221.07 / $350.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$221.07 / $396.00 / $495.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$308.76 / $359.19 / $440.14
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$203.02 / $419.70 / $1,741.43
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$157.41 / $211.77 / $434.97
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$349.16 / $350.19 / $483.63
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$286.81 / $413.86 / $669.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$152.19 / $180.81 / $374.66
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$311.98 / $311.98 / $311.98
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$246.46 / $311.98 / $311.98