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Iowa rates for HCPCS L5679

Addition To Lower Extremity Below Knee/Above Kneecustom Fabricated Fromexisting Mold Or Prefabric Ated Socket Insert Silicone Gel Elastomeric Or Equal Not For Use With Locking Mechanism

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$551.33 / $662.27 / $662.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$296.25 / $401.40 / $622.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$440.05 / $440.05 / $824.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$440.05 / $916.50 / $1,145.63
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$711.80 / $790.68 / $1,040.35
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$477.82 / $974.04 / $3,490.95
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$358.19 / $477.14 / $1,023.70
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.78 / $824.19 / $1,015.31
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$674.99 / $962.77 / $1,574.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$358.19 / $385.35 / $881.55
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$734.27 / $734.27 / $734.27
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$580.07 / $734.27 / $734.27