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Iowa rates for HCPCS L5694

Addition to lower extremity, above knee (AK), pelvic control belt, padded and lined

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$176.61 / $182.38 / $182.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.71 / $130.78 / $183.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.85 / $140.85 / $239.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$203.62 / $252.38 / $315.47
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$211.18 / $236.90 / $284.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.86 / $287.22 / $1,167.33
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.66 / $144.84 / $297.50
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$238.83 / $239.51 / $330.78
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$206.92 / $279.79 / $457.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.66 / $122.60 / $256.12
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$213.39 / $213.39 / $213.39
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$168.58 / $213.39 / $213.39