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Illinois rates for HCPCS L5640

Addition to lower extremity, knee disarticulation, leather socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$437.79 / $437.79 / $437.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$362.90 / $440.00 / $645.15
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,057.34 / $1,788.85 / $7,610.57
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$672.24 / $672.24 / $705.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$572.20 / $572.20 / $882.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$417.71 / $572.20 / $1,025.25
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$751.84 / $967.99 / $1,226.78
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
$1,149.88 / $1,149.88 / $1,149.88
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$466.67 / $666.68 / $700.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$320.68 / $441.28 / $757.53