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Illinois rates for HCPCS L5613

Addition To Lower Extremity Endoskeletal System Above Knee- Knee Disarticulation 4 Bar Linkage With Hydraulic Swing Phase Control

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,455.84 / $1,455.84 / $1,455.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,313.57 / $1,551.32 / $2,506.76
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,515.49 / $5,947.59 / $25,308.73
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,235.48 / $2,235.48 / $2,235.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,902.78 / $1,902.78 / $3,939.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,389.03 / $1,902.78 / $3,409.88
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,500.21 / $3,693.02 / $4,521.13
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
$3,823.86 / $3,823.86 / $3,823.86
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,792.46 / $2,560.66 / $2,688.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,324.97 / $1,467.45 / $2,775.07