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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
$208.93 / $281.84 / $302.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $190.55 / $295.12
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $251.19 / $275.42
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$323.59 / $549.54 / $758.58
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $263.03 / $263.03
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.81 / $39.81 / $39.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.78 / $218.78 / $218.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $162.18 / $323.59
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$208.93 / $295.12 / $436.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $173.78 / $245.47