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Rhode Island rates for HCPCS L5220

Above knee (AK), short prosthesis, no knee joint (stubbies), with articulated ankle/foot, dynamically aligned, each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,548.82 / $1,905.46 / $5,248.07
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,897.79 / $6,760.83 / $7,943.28
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $1,778.28 / $3,630.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,949.84 / $1,949.84 / $2,454.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $1,819.70 / $2,454.71
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,187.76 / $2,570.40 / $4,466.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,584.89 / $2,089.30 / $2,818.38