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Louisiana rates for HCPCS L5696

Addition to lower extremity, above knee (AK) or knee disarticulation, pelvic joint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$143.99 / $152.85 / $217.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$126.03 / $152.85 / $221.52
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$231.89 / $396.14 / $556.83
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.13 / $189.15 / $189.15
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.76 / $138.76 / $138.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.29 / $138.76 / $138.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$251.68 / $296.08 / $296.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.86 / $133.54 / $175.71