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Iowa rates for HCPCS L5677

Additions to lower extremity, below knee (BK), knee joints, polycentric, pair

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$426.58 / $501.19 / $562.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $346.74 / $512.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.11 / $398.11 / $707.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $776.25 / $954.99
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $660.69 / $776.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $812.83 / $3,162.28
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $446.68 / $1,071.52
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $724.44 / $891.25
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.95 / $707.95 / $707.95
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $1,071.52 / $1,071.52
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$295.12 / $457.09 / $954.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $331.13 / $588.84
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $630.96 / $630.96