go back

Illinois rates for HCPCS L5679

Addition To Lower Extremity Below Knee/Above Kneecustom Fabricated Fromexisting Mold Or Prefabric Ated Socket Insert Silicone Gel Elastomeric Or Equal Not For Use With Locking Mechanism

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$391.34 / $391.34 / $391.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$313.80 / $391.34 / $597.80
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$565.32 / $593.01 / $593.01
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$944.46 / $1,597.86 / $6,803.21
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$600.91 / $600.91 / $624.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$440.05 / $440.05 / $824.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$321.24 / $440.05 / $916.50
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$697.76 / $856.12 / $1,085.05
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
$1,027.88 / $1,027.88 / $1,027.88
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.36 / $637.66 / $669.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$279.24 / $394.46 / $677.16