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Louisiana rates for HCPCS L5654

Addition to lower extremity, socket insert, Symes, (Kemblo, Pelite, Aliplast, Plastazote or equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$255.72 / $271.45 / $385.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$209.93 / $271.45 / $393.42
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$411.83 / $703.55 / $988.94
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$280.85 / $335.94 / $335.94
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$306.16 / $306.16 / $306.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.50 / $306.16 / $306.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.38 / $236.05 / $312.70