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Hawaii rates for HCPCS L5671

Addition to lower extremity, below knee (BK)/above knee (AK) suspension locking mechanism (shuttle, lanyard, or equal), excludes socket insert

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$219.39 / $219.39 / $219.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$757.37 / $757.37 / $757.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.63 / $380.63 / $1,048.71
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$953.37 / $998.29 / $998.29
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$572.02 / $953.37 / $1,334.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$496.41 / $664.41 / $1,048.71
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$632.09 / $794.30 / $907.44