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Rhode Island rates for HCPCS L5697

Addition to lower extremity, above knee (AK) or knee disarticulation, pelvic band

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.74 / $61.66 / $199.53
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.21 / $257.04 / $295.12
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.70 / $72.44 / $138.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.26 / $74.13 / $74.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.65 / $43.65 / $60.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.10 / $74.13 / $131.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.54 / $69.18 / $107.15