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Illinois rates for HCPCS L5695

Addition to lower extremity, above knee (AK), pelvic control, sleeve suspension, neoprene or equal, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$96.88 / $96.88 / $96.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.88 / $104.33 / $164.53
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$233.73 / $395.43 / $1,684.10
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$148.75 / $148.75 / $148.75
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$122.31 / $122.31 / $215.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.29 / $122.31 / $226.88
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$189.84 / $229.73 / $280.45
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
$254.45 / $254.45 / $254.45
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.27 / $147.54 / $154.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.38 / $97.65 / $172.91