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Iowa rates for HCPCS L6687

Upper extremity addition, frame type socket, below elbow or wrist disarticulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$579.88 / $579.88 / $671.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.39 / $415.81 / $581.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$432.60 / $432.60 / $761.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$432.60 / $802.50 / $1,003.13
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$671.45 / $759.22 / $911.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$441.50 / $900.00 / $3,605.80
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$342.31 / $460.52 / $945.91
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$759.32 / $761.54 / $1,051.73
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.00 / $889.58 / $1,455.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.55 / $342.31 / $520.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$342.31 / $410.84 / $900.00
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$678.46 / $678.46 / $678.46
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$535.98 / $678.46 / $678.46