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Hawaii rates for HCPCS L5654

Addition to lower extremity, socket insert, Symes, (Kemblo, Pelite, Aliplast, Plastazote or equal)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.91 / $154.91 / $154.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$410.10 / $410.10 / $410.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$306.16 / $306.16 / $567.85
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$516.23 / $540.54 / $540.54
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.74 / $516.23 / $722.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$280.36 / $410.10 / $567.85
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$225.78 / $415.84 / $491.35