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Illinois rates for HCPCS L5642

Addition To Lower Extremity Above Knee Leather Socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$405.81 / $405.81 / $405.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$333.55 / $405.81 / $625.10
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$979.44 / $1,657.04 / $7,054.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$530.41 / $530.41 / $838.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$387.20 / $387.20 / $960.13
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$696.93 / $912.26 / $1,147.89
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
$1,065.90 / $1,065.90 / $1,065.90
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$432.58 / $617.98 / $648.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$312.16 / $409.05 / $815.30