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Illinois rates for HCPCS L5520

Preparatory, below knee (BK) PTB type socket, nonalignable system, pylon, no cover, SACH foot, thermoplastic or equal, direct formed

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$943.17 / $943.17 / $943.17
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$770.79 / $1,015.72 / $1,450.90
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,276.88 / $3,852.08 / $16,396.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,232.72 / $1,232.72 / $2,317.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$899.89 / $1,232.72 / $2,209.13
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,619.77 / $2,477.29 / $2,978.91
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
$2,477.29 / $2,477.29 / $2,477.29
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,075.76 / $1,536.81 / $1,613.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$721.18 / $950.69 / $1,683.42