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Georgia rates for HCPCS L5694

Addition to lower extremity, above knee (AK), pelvic control belt, padded and lined

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$90.71 / $90.71 / $256.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.71 / $128.80 / $183.03
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$217.74 / $304.83 / $799.11
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.09 / $181.05 / $347.62
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$185.08 / $217.74 / $426.77
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$185.08 / $185.08 / $185.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.85 / $140.85 / $140.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.82 / $102.82 / $290.77
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.48 / $217.74 / $302.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.06 / $108.63 / $179.22