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Hawaii rates for HCPCS L5230

Above knee (AK), for proximal femoral focal deficiency, constant friction knee, shin, SACH foot

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,677.92 / $1,677.92 / $1,677.92
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,514.98 / $5,514.98 / $5,514.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,853.06 / $2,853.06 / $7,636.44
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,942.22 / $7,269.34 / $7,269.34
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,165.33 / $6,942.22 / $9,719.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,410.06 / $5,514.98 / $7,636.44
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,036.07 / $5,592.22 / $6,607.71