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Illinois rates for HCPCS L5643

Addition To Lower Extremity Hip Disarticulation Flexible Inner Socket External Frame

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,196.95 / $1,196.95 / $1,196.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$834.25 / $1,196.95 / $1,570.35
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,889.03 / $4,887.72 / $20,808.09
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,837.95 / $1,837.95 / $1,837.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,167.30 / $1,167.30 / $2,054.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$852.13 / $1,167.30 / $2,803.50
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,934.69 / $2,395.90 / $2,911.08
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
$3,143.87 / $3,143.87 / $3,143.87
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,365.22 / $1,950.32 / $2,047.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$811.34 / $1,206.49 / $2,136.37