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Illinois rates for HCPCS L5857

Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing phase only, includes electronic sensor(s), any type

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,128.61 / $5,128.61 / $10,471.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,466.84 / $5,248.07 / $10,232.93
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,302.69 / $19,952.62 / $70,794.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,606.93 / $6,606.93 / $11,481.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,897.79 / $4,897.79 / $11,220.18
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,511.38 / $10,232.93 / $12,589.25
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
$13,489.63 / $13,489.63 / $13,489.63
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,309.57 / $6,309.57 / $8,912.51
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,165.95 / $8,317.64 / $15,135.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,890.45 / $5,128.61 / $7,943.28