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Illinois rates for HCPCS L5701

Replacement Socket Above Knee/Knee Disarticulation Including Attachment Plate Molded To Patient Model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,273.67 / $2,273.67 / $2,273.67
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,807.98 / $2,273.67 / $3,675.06
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,488.68 / $9,285.87 / $39,526.23
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,491.30 / $3,491.30 / $3,491.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,550.04 / $2,550.04 / $5,234.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,861.53 / $2,550.04 / $5,325.75
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,904.75 / $4,945.57 / $6,267.75
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
$5,971.97 / $5,971.97 / $5,971.97
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,423.67 / $3,462.40 / $3,635.52
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,593.82 / $6,529.56 / $12,134.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,705.15 / $2,291.81 / $3,934.27