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Hawaii rates for HCPCS L5668

Addition to lower extremity, below knee (BK), molded distal cushion

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.70 / $72.44 / $114.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.13 / $89.13 / $144.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $162.18 / $229.09
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $186.21 / $194.98
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $186.21 / $213.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.43 / $81.28 / $95.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $125.89 / $199.53