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Louisiana rates for HCPCS L5655

Addition to lower extremity, socket insert, below knee (BK) (Kemblo, Pelite, Aliplast, Plastazote or equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$198.94 / $211.18 / $299.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.75 / $211.18 / $306.06
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$320.38 / $547.33 / $769.34
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.49 / $261.33 / $261.33
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$221.07 / $221.07 / $221.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.38 / $221.07 / $221.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.88 / $186.53 / $244.74