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Hawaii rates for HCPCS L5105

Below knee (BK), plastic socket, joints and thigh lacer, SACH foot

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,867.40 / $1,867.40 / $1,867.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,248.01 / $5,248.01 / $5,248.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,006.81 / $3,006.81 / $7,266.78
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,606.16 / $6,917.44 / $6,917.44
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,963.70 / $6,606.16 / $9,248.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,547.80 / $5,248.01 / $7,266.78
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,889.10 / $5,321.51 / $6,287.85