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Iowa rates for HCPCS L5673

Addition To Lower Extremity Below Knee/Above Kneecustom Fabricated From Existing Mold Or Prefabricated Socket Insert Silicone Gel Elastomeric Or Equal For Use With Locking Mechanism

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$661.63 / $794.75 / $794.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$355.52 / $481.70 / $747.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.15 / $501.15 / $989.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.15 / $1,099.88 / $1,374.84
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$854.15 / $948.84 / $1,248.30
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$573.37 / $1,168.83 / $4,189.30
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$429.83 / $572.58 / $1,228.44
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$986.12 / $989.01 / $1,218.39
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$810.00 / $1,155.30 / $1,889.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$429.83 / $463.51 / $1,057.96
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$881.12 / $881.12 / $881.12
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$696.08 / $881.12 / $881.12