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Hawaii rates for HCPCS L5699

All lower extremity prostheses, shoulder harness

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $131.83 / $204.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.82 / $169.82 / $331.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $371.54 / $524.81
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.58 / $426.58 / $446.68
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $426.58 / $489.78
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$147.91 / $151.36 / $177.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $288.40 / $457.09