go back

Rhode Island rates for HCPCS L5505

Initial, above knee (AK), knee disarticulation, ischial level socket, nonalignable system, pylon, no cover, SACH foot, plaster socket, direct formed

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,073.75 / $1,253.82 / $1,457.55
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,474.57 / $4,692.88 / $5,555.81
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,097.78 / $1,291.50 / $2,159.92
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,421.48 / $1,620.00 / $1,620.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,182.59 / $1,620.00 / $1,620.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,783.46 / $2,783.46 / $2,783.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,108.10 / $1,403.46 / $2,043.38