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Illinois rates for HCPCS L5968

Addition To Lower Limb Prosthesis Multiaxial Ankle With Swing Phase Active Dorsiflexion Feature

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,171.26 / $2,171.26 / $2,171.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,912.12 / $2,171.26 / $3,599.30
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,242.22 / $8,868.93 / $37,745.74
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,334.03 / $3,334.03 / $3,334.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,448.80 / $2,448.80 / $4,801.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,787.62 / $2,448.80 / $5,085.75
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,728.85 / $5,044.91 / $6,141.63
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
$5,702.94 / $5,702.94 / $5,702.94
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,673.30 / $3,819.00 / $4,009.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,670.20 / $2,188.57 / $3,875.36