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Illinois rates for HCPCS L5697

Addition To Lower Extremity Above Knee Or Knee Disarticulation Pelvic Band

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.57 / $55.57 / $55.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.28 / $55.57 / $81.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$133.56 / $225.96 / $966.08
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.33 / $85.33 / $85.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.21 / $60.21 / $105.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.95 / $60.21 / $130.13
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.35 / $116.84 / $150.54
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
$145.96 / $145.96 / $145.96
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.24 / $84.63 / $88.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.75 / $56.02 / $96.16