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Illinois rates for HCPCS L5985

All endoskeletal lower extremity prostheses, dynamic prosthetic pylon

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$168.73 / $168.73 / $168.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$148.59 / $168.73 / $279.70
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$407.04 / $688.64 / $2,933.23
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$259.08 / $259.08 / $272.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$220.51 / $220.51 / $372.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.97 / $220.51 / $395.25
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.27 / $357.96 / $454.50
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
$443.18 / $443.18 / $443.18
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$207.73 / $296.77 / $311.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.06 / $170.07 / $291.95