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Louisiana rates for HCPCS L5685

Addition to lower extremity prosthesis, below knee, suspension/sealing sleeve, with or without valve, any material, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$84.00 / $89.17 / $126.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.05 / $89.17 / $129.22
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$155.41 / $155.41 / $155.41
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$135.28 / $231.10 / $324.85
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.26 / $110.35 / $110.35
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.53 / $190.53 / $190.53
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.03 / $100.03 / $100.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.02 / $100.03 / $100.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.94 / $80.59 / $109.87