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Hawaii rates for HCPCS L5220

Above knee (AK), short prosthesis, no knee joint (stubbies), with articulated ankle/foot, dynamically aligned, each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,302.55 / $1,302.55 / $1,302.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,356.42 / $4,356.42 / $4,356.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,482.86 / $2,482.86 / $6,032.20
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,483.82 / $5,742.22 / $5,742.22
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,290.29 / $5,483.82 / $7,677.35
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,182.50 / $2,182.50 / $2,239.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,527.40 / $4,356.42 / $6,032.20
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,398.26 / $4,417.42 / $5,219.58