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Hawaii rates for HCPCS L5595

Preparatory, hip disarticulation/hemipelvectomy, pylon, no cover, SACH foot, thermoplastic or equal, molded to patient model

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,960.58 / $1,960.58 / $1,960.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,719.82 / $8,719.82 / $8,719.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,578.08 / $12,074.07 / $12,074.07
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,976.43 / $11,493.64 / $11,493.64
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,585.86 / $10,976.43 / $15,367.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,689.51 / $7,649.53 / $12,074.07
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,800.38 / $6,857.68 / $10,447.53