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Georgia rates for HCPCS L5658

Addition To Lower Extremity Socket Insert Above Knee (Kemblo Pelite Aliplast Plastazote Or Equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$181.80 / $181.80 / $514.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.80 / $258.14 / $366.84
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.40 / $610.96 / $1,601.59
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$232.66 / $362.86 / $696.69
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$370.94 / $465.78 / $807.34
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$370.94 / $370.94 / $370.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$366.26 / $366.26 / $366.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$267.37 / $346.87 / $583.34
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.66 / $436.40 / $606.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$145.13 / $217.72 / $359.19