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Louisiana rates for HCPCS L5694

Addition to lower extremity, above knee (AK), pelvic control belt, padded and lined

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$156.91 / $166.57 / $236.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.11 / $166.57 / $241.40
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$252.70 / $431.70 / $606.80
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$172.33 / $206.13 / $206.13
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.85 / $140.85 / $140.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.82 / $102.82 / $252.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.42 / $144.84 / $174.19