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Georgia rates for HCPCS L5656

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.21 / $186.21 / $549.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $257.04 / $416.87
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.09 / $1,096.48 / $1,698.24
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.88 / $380.19 / $602.56
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$389.05 / $389.05 / $389.05
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.05 / $389.05 / $389.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$338.84 / $338.84 / $794.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $245.47 / $549.54
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $457.09 / $630.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.82 / $331.13 / $354.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $223.87 / $389.05