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Iowa rates for HCPCS L5696

Addition to lower extremity, above knee (AK) or knee disarticulation, pelvic joint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$161.57 / $198.04 / $198.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.51 / $133.38 / $194.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.76 / $138.76 / $260.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.76 / $274.13 / $342.66
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$222.07 / $237.05 / $290.27
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$151.16 / $308.17 / $1,184.51
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.32 / $151.41 / $323.87
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$259.98 / $260.76 / $337.36
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.55 / $304.58 / $498.28
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$355.31 / $355.31 / $577.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.32 / $125.79 / $310.67
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$232.31 / $232.31 / $232.31
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$183.52 / $232.31 / $232.31