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Iowa rates for HCPCS L5976

All lower extremity prostheses, energy storing foot (Seattle Carbon Copy II or equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$528.00 / $594.23 / $594.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$280.01 / $403.70 / $590.92
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$420.01 / $420.01 / $832.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$420.01 / $822.38 / $1,027.97
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$672.17 / $757.14 / $879.10
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$482.84 / $984.28 / $3,565.60
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$361.95 / $468.43 / $1,032.31
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$830.41 / $832.85 / $1,021.12
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$682.09 / $972.88 / $1,591.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$349.23 / $390.31 / $922.29
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$742.00 / $742.00 / $742.00
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$586.17 / $742.00 / $742.00