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Iowa rates for HCPCS L5920

Addition Endoskeletal System Above Knee Or Hip Disarticulation Alignable System

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$533.41 / $533.41 / $613.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$265.29 / $382.49 / $535.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$397.94 / $397.94 / $700.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$397.94 / $738.38 / $922.97
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$617.64 / $693.01 / $831.90
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$406.13 / $840.01 / $3,385.23
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$314.88 / $423.62 / $870.11
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$698.49 / $700.52 / $967.46
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$622.00 / $818.32 / $1,338.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$314.88 / $387.42 / $834.63
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$624.10 / $624.10 / $624.10
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$493.04 / $624.10 / $624.10