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Rhode Island rates for HCPCS L5655

Addition to lower extremity, socket insert, below knee (BK) (Kemblo, Pelite, Aliplast, Plastazote or equal)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.54 / $191.21 / $224.71
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$535.69 / $723.53 / $856.57
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.33 / $213.33 / $342.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$219.14 / $221.07 / $221.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.38 / $221.07 / $221.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.83 / $216.38 / $315.04