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Rhode Island rates for HCPCS L5976

All lower extremity prostheses, energy storing foot (Seattle Carbon Copy II or equal)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$360.33 / $403.70 / $489.12
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,165.99 / $1,574.85 / $1,864.43
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$538.65 / $538.65 / $745.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$420.01 / $420.01 / $477.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$306.61 / $420.01 / $420.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.86 / $470.98 / $685.72