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Illinois rates for HCPCS L5658

Addition to lower extremity, socket insert, above knee (AK) (Kemblo, Pelite, Aliplast, Plastazote or equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$271.22 / $271.22 / $271.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.46 / $271.22 / $410.10
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$655.08 / $1,108.28 / $4,715.01
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.46 / $416.46 / $416.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$366.26 / $366.26 / $577.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$267.37 / $366.26 / $635.25
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$438.38 / $539.62 / $655.66
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
$712.37 / $712.37 / $712.37
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.35 / $441.94 / $464.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$182.26 / $273.38 / $469.31