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Louisiana rates for HCPCS L5697

Addition To Lower Extremity Above Knee Or Knee Disarticulation Pelvic Band

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.07 / $55.28 / $78.51
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.07 / $55.28 / $80.11
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.86 / $143.26 / $201.37
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.19 / $68.41 / $68.41
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.21 / $60.21 / $60.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.95 / $60.21 / $60.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.04 / $48.07 / $74.06