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Illinois rates for HCPCS L5200

Above Knee Molded Socket Single Axis Constant Friction Knee Shin Sach Foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,171.94 / $2,171.94 / $2,171.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,783.36 / $2,171.94 / $3,690.48
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,243.82 / $8,871.62 / $37,757.48
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,335.07 / $3,335.07 / $3,335.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,728.17 / $2,728.17 / $4,656.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,991.56 / $1,991.56 / $5,138.12
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,730.01 / $4,837.58 / $6,143.55
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
$5,704.73 / $5,704.73 / $5,704.73
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,477.27 / $3,538.97 / $3,715.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,656.68 / $2,189.23 / $3,876.56