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Illinois rates for HCPCS L5964

Addition, endoskeletal system, above knee (AK), flexible protective outer surface covering system

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$669.79 / $669.79 / $669.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$531.50 / $669.79 / $1,077.56
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,617.03 / $2,735.73 / $11,643.84
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,028.49 / $1,028.49 / $1,028.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$702.38 / $702.38 / $1,518.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.74 / $702.38 / $1,569.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,112.22 / $1,359.54 / $1,723.08
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
$1,759.25 / $1,759.25 / $1,759.25
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$824.66 / $1,178.08 / $1,236.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.32 / $675.13 / $1,158.98