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Louisiana rates for HCPCS L5698

Addition to lower extremity, above knee (AK) or knee disarticulation, Silesian bandage

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.64 / $82.41 / $117.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.48 / $82.41 / $119.44
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.03 / $213.59 / $300.24
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.25 / $101.98 / $101.98
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.25 / $99.25 / $99.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.45 / $72.45 / $166.88
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.10 / $82.54 / $83.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.64 / $72.68 / $99.06