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Georgia rates for HCPCS L5695

Addition to lower extremity, above knee (AK), pelvic control, sleeve suspension, neoprene or equal, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.73 / $83.73 / $416.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.73 / $114.26 / $133.97
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$143.72 / $143.72 / $143.72
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$200.99 / $281.39 / $737.63
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.17 / $167.13 / $320.89
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$166.37 / $194.15 / $371.83
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.84 / $170.84 / $170.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$122.31 / $122.31 / $122.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.29 / $122.31 / $226.88
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$152.75 / $200.99 / $279.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.84 / $100.28 / $165.45