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Illinois rates for HCPCS L5698

Addition To Lower Extremity Above Knee Or Knee Disarticulation Silesian Bandage

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.29 / $71.29 / $71.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.32 / $71.29 / $125.78
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$171.72 / $290.52 / $1,239.39
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.47 / $109.47 / $109.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.25 / $99.25 / $153.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.45 / $72.45 / $168.54
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.84 / $169.92 / $205.28
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
$187.25 / $187.25 / $187.25
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.99 / $108.57 / $113.99
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.16 / $82.54 / $94.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.31 / $71.86 / $123.36