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Illinois rates for HCPCS L5220

Above Knee Short Prosthesis No Knee Joint (Stubbies) With Articulated Ankle/Foot Dynamically Aligned Each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,899.67 / $1,899.67 / $1,899.67
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,478.41 / $1,988.34 / $2,856.51
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,585.56 / $7,757.96 / $33,024.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,916.99 / $2,916.99 / $2,916.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,482.86 / $2,482.86 / $4,025.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,812.49 / $2,482.86 / $4,449.75
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,254.13 / $3,977.74 / $4,990.38
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
$4,989.60 / $4,989.60 / $4,989.60
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,024.99 / $2,892.85 / $3,037.49
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,182.50 / $2,307.14 / $3,838.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,461.28 / $1,914.82 / $3,816.52