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Hawaii rates for HCPCS L3260

Surgical boot/shoe, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.79 / $28.79 / $28.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.95 / $18.75 / $36.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.37 / $15.37 / $15.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.12 / $21.12 / $21.12
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.27 / $2.27 / $2.27
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.00 / $8.00 / $20.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.09 / $12.16 / $15.37
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.54 / $12.79 / $15.05