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Illinois rates for HCPCS L5673

Addition To Lower Extremity Below Knee/Above Kneecustom Fabricated From Existing Mold Or Prefabricated Socket Insert Silicone Gel Elastomeric Or Equal For Use With Locking Mechanism

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$469.62 / $469.62 / $469.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$376.57 / $469.62 / $717.41
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,133.67 / $1,889.45 / $8,163.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$721.12 / $721.12 / $811.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.15 / $501.15 / $989.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$365.84 / $501.15 / $1,099.88
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$806.51 / $984.60 / $1,327.50
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
$1,233.49 / $1,233.49 / $1,233.49
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$535.64 / $765.21 / $803.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$335.10 / $473.36 / $812.61