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Louisiana rates for HCPCS L5975

All lower extremity prostheses, combination single axis ankle and flexible keel foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$304.10 / $322.82 / $458.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$246.35 / $322.82 / $467.85
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.75 / $836.66 / $1,176.03
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$333.99 / $399.50 / $399.50
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$362.03 / $362.03 / $362.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$264.27 / $362.03 / $362.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.28 / $286.14 / $395.58