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Illinois rates for HCPCS L5975

All Lower Extremity Prosthesis Combination Single Axis Ankle And Flexible Keel Foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$277.00 / $277.00 / $277.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$243.93 / $277.00 / $459.17
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$669.39 / $1,132.49 / $4,815.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$362.03 / $362.03 / $612.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$264.27 / $362.03 / $648.75
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$475.72 / $604.14 / $773.48
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
$727.57 / $727.57 / $727.57
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$341.05 / $487.22 / $511.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.89 / $279.20 / $490.26