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Illinois rates for HCPCS L5971

All lower extremity prostheses, solid ankle cushion heel (SACH) foot, replacement only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$129.79 / $129.79 / $129.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.67 / $138.00 / $204.90
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$313.23 / $529.92 / $2,256.19
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.29 / $199.29 / $199.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$159.21 / $159.21 / $276.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.22 / $159.21 / $304.13
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$244.09 / $301.56 / $367.12
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
$340.90 / $340.90 / $340.90
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$159.79 / $228.28 / $239.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.34 / $130.82 / $224.57