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Illinois rates for HCPCS L1850

Knee Orthosis Swedish Type Prefabricated Off- The- Shelf (Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$132.32 / $132.32 / $224.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.15 / $132.50 / $224.35
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$399.90 / $692.45 / $2,271.69
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$148.11 / $170.51 / $170.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$214.95 / $214.95 / $319.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$156.91 / $209.30 / $256.13
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.13 / $332.31 / $433.95
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
$291.66 / $291.66 / $291.66
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.66 / $198.10 / $208.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$146.07 / $171.25 / $300.68