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Hawaii rates for HCPCS L5650

Additions to lower extremity, total contact, above knee (AK) or knee disarticulation socket

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $338.84 / $489.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.19 / $380.19 / $691.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $776.25 / $1,096.48
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $870.96 / $912.01
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $870.96 / $1,023.29
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$389.05 / $398.11 / $467.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $602.56 / $954.99