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Iowa rates for HCPCS L5822

Addition Endoskeletal Knee-Shin System Single Axis Pneumatic Swing Friction Stance Phase Control

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,644.69 / $1,771.06 / $1,771.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.43 / $1,227.57 / $1,771.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,367.82 / $1,367.82 / $2,248.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,367.82 / $2,451.38 / $3,064.22
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,982.32 / $2,114.46 / $2,519.30
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,303.42 / $2,657.06 / $10,228.89
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,010.58 / $1,359.57 / $2,792.55
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,241.71 / $2,248.28 / $3,104.99
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,926.97 / $2,642.37 / $4,296.42
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.63 / $1,010.58 / $1,536.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,010.58 / $1,212.90 / $2,678.69
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,003.01 / $2,003.01 / $2,003.01
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,582.38 / $2,003.01 / $2,003.01