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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
$204.17 / $269.15 / $776.25
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.31 / $1,000.00 / $1,174.90
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $331.13 / $537.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$295.12 / $295.12 / $363.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $269.15 / $363.08
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.40 / $338.84 / $588.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $288.40 / $426.58