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Hawaii rates for HCPCS L5617

Addition to lower extremity, quick change self-aligning unit, above knee (AK) or below knee (BK), each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$247.14 / $247.14 / $247.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$565.62 / $565.62 / $565.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.96 / $436.96 / $783.19
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$711.99 / $745.54 / $745.54
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$427.19 / $711.99 / $996.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$463.61 / $565.62 / $783.19
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$311.37 / $573.54 / $677.68