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Louisiana rates for HCPCS L5677

Additions to lower extremity, below knee (BK), knee joints, polycentric, pair

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$426.45 / $452.70 / $642.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$345.46 / $452.70 / $656.08
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$686.78 / $1,173.27 / $1,649.19
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$468.37 / $560.22 / $560.22
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$400.78 / $400.78 / $400.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.57 / $400.78 / $400.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$196.82 / $393.65 / $580.52