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Illinois rates for HCPCS 21175

Rcnstj Bifrontal Superior-Lat Orb Rims & Lwr Fhd

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,017.00 / $3,335.00 / $6,707.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,920.96 / $2,141.51 / $4,145.06
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,139.91 / $24,097.64 / $52,560.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,664.12 / $3,588.79 / $4,509.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$875.00 / $875.00 / $908.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,227.02 / $3,210.90 / $4,707.45
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,497.37 / $3,652.21 / $15,545.53
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,572.35 / $2,792.87 / $3,091.99
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $3,496.32
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,132.00 / $5,951.00 / $11,831.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,091.42 / $2,906.63 / $4,940.67