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Iowa rates for HCPCS L5857

Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing phase only, includes electronic sensor(s), any type

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,585.78 / $7,943.28 / $8,709.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,365.16 / $5,248.07 / $8,709.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,606.93 / $6,606.93 / $11,481.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,606.93 / $12,022.64 / $14,791.08
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,709.64 / $10,232.93 / $10,715.19
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,918.31 / $13,182.57 / $47,863.01
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,897.79 / $6,918.31 / $16,982.44
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11,220.18 / $11,748.98 / $14,125.38
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,481.54 / $11,481.54 / $11,481.54
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,471.29 / $16,982.44 / $16,982.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,570.88 / $7,585.78 / $15,135.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,677.35 / $5,248.07 / $9,332.54
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,943.28 / $10,000.00 / $10,000.00