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Illinois rates for HCPCS L5972

All lower extremity prostheses, foot, flexible keel

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$236.42 / $236.42 / $236.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$188.90 / $243.17 / $382.75
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$570.80 / $965.71 / $4,110.05
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.04 / $363.04 / $363.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$293.77 / $293.77 / $515.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$214.45 / $293.77 / $553.88
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$406.03 / $525.45 / $668.75
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
$620.98 / $620.98 / $620.98
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.66 / $385.24 / $404.50
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$477.68 / $676.80 / $1,257.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.86 / $238.31 / $409.10