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Hawaii rates for HCPCS L5642

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$326.12 / $326.12 / $326.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$508.17 / $508.17 / $508.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$530.41 / $703.64 / $703.64
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$639.66 / $669.81 / $669.81
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$383.80 / $639.66 / $895.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$445.79 / $598.09 / $703.64
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$279.75 / $515.29 / $608.85