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Illinois rates for HCPCS L5595

Preparatory Hip Disarticulation-Hemipelvectomy Pylon No Cover Sach Foot Thermoplastic Or Equal Molded To Patient Model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,737.63 / $2,737.63 / $2,737.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,264.83 / $2,737.63 / $4,284.83
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,609.63 / $11,182.33 / $47,591.61
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,578.08 / $3,578.08 / $5,316.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,612.00 / $2,612.00 / $6,412.50
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,701.52 / $8,870.67 / $10,799.08
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
$7,190.56 / $7,190.56 / $7,190.56
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,122.51 / $4,460.72 / $4,683.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,155.94 / $2,759.45 / $4,886.25