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Rhode Island rates for HCPCS L5858

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,568.04 / $12,037.88 / $12,987.91
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30,961.33 / $41,817.36 / $49,506.85
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,782.03 / $11,508.27 / $19,246.73
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,513.81 / $14,513.81 / $14,513.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,595.08 / $14,513.81 / $14,513.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,874.11 / $14,345.15 / $18,208.18