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Illinois rates for HCPCS L5628

Addition To Lower Extremity Test Socket Hemipelvectomy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$382.42 / $382.42 / $382.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$289.07 / $382.42 / $514.37
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$923.79 / $1,562.89 / $6,648.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$587.22 / $587.22 / $587.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$499.82 / $499.82 / $668.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$364.87 / $499.82 / $895.88
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$618.13 / $1,143.00 / $1,383.46
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
$1,004.46 / $1,004.46 / $1,004.46
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.19 / $623.13 / $654.28
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.30 / $382.03 / $435.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$258.52 / $385.47 / $714.64