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Rhode Island rates for HCPCS L5679

Addition To Lower Extremity Below Knee/Above Kneecustom Fabricated Fromexisting Mold Or Prefabric Ated Socket Insert Silicone Gel Elastomeric Or Equal Not For Use With Locking Mechanism

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$344.75 / $401.40 / $467.98
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,115.58 / $1,506.75 / $1,783.82
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$438.06 / $515.37 / $713.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$440.05 / $440.05 / $440.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$321.24 / $440.05 / $440.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$355.78 / $450.61 / $656.07