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Illinois rates for HCPCS L5614

Addition to lower extremity, exoskeletal system, above knee (AK), knee disarticulation, four-bar linkage, with pneumatic swing phase control

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,008.27 / $1,008.27 / $1,008.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$887.92 / $1,008.27 / $1,671.38
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,434.29 / $4,118.39 / $17,527.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,317.79 / $1,317.79 / $2,229.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$961.99 / $1,317.79 / $2,361.75
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,637.51 / $2,037.14 / $2,536.87
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
$2,648.28 / $2,648.28 / $2,648.28
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,241.40 / $1,773.43 / $1,862.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$760.37 / $1,016.30 / $1,744.66