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Hawaii rates for HCPCS L5624

Addition to lower extremity, test socket, above knee (AK)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$185.27 / $185.27 / $185.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.03 / $436.03 / $436.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$311.77 / $311.77 / $603.75
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$548.86 / $574.72 / $574.72
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$329.32 / $548.86 / $768.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$333.13 / $436.03 / $603.75
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$240.04 / $442.14 / $522.41