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Hawaii rates for HCPCS L5637

Addition to lower extremity, below knee (BK), total contact

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $218.78 / $389.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$234.42 / $234.42 / $380.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $426.58 / $602.56
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $489.78 / $512.86
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $489.78 / $562.34
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$229.09 / $234.42 / $275.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.17 / $331.13 / $524.81