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Rhode Island rates for HCPCS L5857

Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing phase only, includes electronic sensor(s), any type

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,466.84 / $5,495.41 / $15,848.93
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15,135.61 / $20,417.38 / $23,988.33
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,073.80 / $5,495.41 / $10,964.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,606.93 / $6,606.93 / $6,606.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,897.79 / $4,897.79 / $6,606.93
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,025.60 / $7,079.46 / $12,589.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,677.35 / $5,888.44 / $8,709.64