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Louisiana rates for HCPCS L5781

Addition To Lower Limb Prosthesis Vacuum Pump Residual Limb Volume Management And Moisture Evacuation System

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,624.51 / $2,786.01 / $3,956.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,126.06 / $2,786.01 / $4,037.70
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,226.66 / $7,220.62 / $10,149.57
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,882.43 / $3,447.77 / $3,447.77
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,886.72 / $2,886.72 / $2,886.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,107.31 / $2,886.72 / $2,886.72
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,890.35 / $5,753.36 / $5,753.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,435.14 / $2,470.44 / $3,317.27