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Louisiana rates for HCPCS L5200

Above knee (AK), molded socket, single axis constant friction knee, shin, SACH foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,456.12 / $2,607.27 / $3,703.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,106.14 / $2,607.27 / $3,778.65
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,955.49 / $6,757.36 / $9,498.39
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,697.51 / $3,226.58 / $3,226.58
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,728.17 / $2,728.17 / $2,728.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,991.56 / $1,991.56 / $5,087.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.72 / $2,267.19 / $3,048.16