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Hawaii rates for HCPCS L5250

Hip disarticulation, Canadian type; molded socket, hip joint, single axis constant friction knee, shin, SACH foot

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,444.46 / $2,444.46 / $2,444.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,825.79 / $8,825.79 / $8,825.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,366.38 / $4,366.38 / $12,220.85
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11,109.86 / $11,633.36 / $11,633.36
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,665.92 / $11,109.86 / $15,553.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,178.07 / $8,825.79 / $12,220.85
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,858.71 / $8,949.40 / $10,574.53