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Iowa rates for HCPCS L5697

Addition To Lower Extremity Above Knee Or Knee Disarticulation Pelvic Band

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$76.39 / $94.05 / $94.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.14 / $57.87 / $84.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.21 / $60.21 / $105.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.21 / $130.13 / $162.66
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.45 / $112.28 / $126.26
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.45 / $127.02 / $510.07
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.64 / $64.09 / $131.63
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$105.68 / $105.99 / $146.36
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.50 / $125.26 / $202.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.64 / $54.26 / $113.44
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$94.42 / $94.42 / $94.42
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.59 / $94.42 / $94.42