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Georgia rates for HCPCS L5655

Addition to lower extremity, socket insert, below knee (BK) (Kemblo, Pelite, Aliplast, Plastazote or equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.52 / $140.52 / $2,359.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.52 / $184.15 / $270.77
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$337.33 / $472.26 / $1,238.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$179.84 / $280.48 / $538.52
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$286.47 / $290.47 / $624.05
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$286.73 / $286.73 / $286.73
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$221.07 / $221.07 / $221.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.38 / $216.31 / $396.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$256.37 / $337.33 / $468.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.36 / $168.29 / $277.64