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Illinois rates for HCPCS L5654

Addition To Lower Extremity Socket Insert Symes (Kemblo Pelite Aliplast Plastazote Or Equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$234.26 / $234.26 / $234.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.76 / $234.26 / $334.61
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$566.04 / $957.64 / $4,072.48
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$359.71 / $359.71 / $359.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$306.16 / $306.16 / $468.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.50 / $306.16 / $548.63
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$386.71 / $473.30 / $599.10
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
$615.29 / $615.29 / $615.29
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$267.19 / $381.70 / $400.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.32 / $236.12 / $395.29