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Louisiana rates for HCPCS L5658

Addition To Lower Extremity Socket Insert Above Knee (Kemblo Pelite Aliplast Plastazote Or Equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$235.86 / $250.37 / $355.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$203.31 / $250.37 / $362.86
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$379.84 / $648.90 / $912.12
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$259.04 / $309.83 / $309.83
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$366.26 / $366.26 / $366.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$267.37 / $366.26 / $366.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$145.13 / $226.29 / $335.50