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Iowa rates for HCPCS L5699

All Lower Extremity Prostheses Shoulder Harness

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.82 / $206.20 / $206.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.94 / $134.41 / $238.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.96 / $169.96 / $246.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$230.24 / $285.38 / $356.72
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$217.05 / $283.83 / $347.32
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$142.72 / $295.02 / $1,197.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.65 / $148.86 / $305.77
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.45 / $246.17 / $339.98
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$201.61 / $290.93 / $470.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.65 / $115.37 / $263.29
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$219.31 / $219.31 / $219.31
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.25 / $219.31 / $219.31