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Rhode Island rates for HCPCS L5658

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$221.73 / $262.10 / $300.98
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$717.49 / $969.05 / $1,147.24
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.46 / $331.46 / $458.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$293.52 / $366.26 / $366.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$267.37 / $366.26 / $366.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$228.82 / $290.29 / $421.95