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Illinois rates for HCPCS L5990

Addition To Lower Extremity Prosthesis User Adjustable Heel Height

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,083.96 / $1,083.96 / $1,083.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.62 / $1,083.96 / $1,796.94
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,617.14 / $4,427.74 / $18,843.87
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,664.45 / $1,664.45 / $1,664.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,222.54 / $1,222.54 / $2,397.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$892.45 / $892.45 / $2,691.47
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,861.56 / $2,518.58 / $3,066.10
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
$2,847.09 / $2,847.09 / $2,847.09
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,334.59 / $1,906.56 / $2,001.88
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,190.07 / $3,130.40 / $5,817.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$817.49 / $1,092.59 / $1,934.70