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Iowa rates for HCPCS L5658

Addition To Lower Extremity Socket Insert Above Knee (Kemblo Pelite Aliplast Plastazote Or Equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$363.93 / $458.99 / $458.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.80 / $267.57 / $410.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$366.26 / $366.26 / $577.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$366.26 / $635.25 / $794.06
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$448.75 / $525.42 / $549.88
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$335.08 / $675.16 / $2,323.85
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.72 / $319.64 / $717.90
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$576.29 / $577.97 / $692.71
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$465.59 / $662.97 / $1,104.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $270.87 / $618.25
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$514.91 / $514.91 / $514.91
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$406.79 / $514.91 / $514.91