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Louisiana rates for HCPCS L5628

Addition To Lower Extremity Test Socket Hemipelvectomy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$372.66 / $395.60 / $561.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$301.89 / $395.60 / $573.33
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$600.16 / $1,025.29 / $1,441.18
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$409.28 / $489.57 / $489.57
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$499.82 / $499.82 / $499.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$364.87 / $499.82 / $499.82
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.46 / $382.03 / $385.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$192.74 / $344.00 / $455.72