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Illinois rates for HCPCS L5668

Addition to lower extremity, below knee (BK), molded distal cushion

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.61 / $67.61 / $141.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.54 / $72.44 / $141.25
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $104.71 / $123.03
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.96 / $269.15 / $954.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $104.71 / $104.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.13 / $89.13 / $138.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $64.57 / $138.04
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $154.88 / $194.98
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
$177.83 / $177.83 / $177.83
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $77.62 / $112.20
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.28 / $109.65 / $199.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.48 / $69.18 / $102.33