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Iowa rates for HCPCS L6697

Addition To Upper Extremity Prosthesis Below Elbow/Above Elbow Custom

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,170.33 / $1,330.08 / $1,330.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$665.09 / $852.21 / $1,342.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,111.22 / $1,111.22 / $1,738.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,485.10 / $1,840.88 / $2,301.09
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,508.58 / $1,685.25 / $2,065.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,007.69 / $2,054.17 / $7,396.37
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$755.41 / $988.85 / $2,158.92
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,733.08 / $1,738.15 / $2,155.56
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,423.56 / $2,030.41 / $3,321.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$728.86 / $818.12 / $2,064.37
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,548.54 / $1,548.54 / $1,548.54
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,223.34 / $1,548.54 / $1,548.54