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Hawaii rates for HCPCS L5701

Replacement, socket, above knee (AK)/knee disarticulation, including attachment plate, molded to patient model

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $2,454.71 / $3,890.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,570.40 / $2,570.40 / $4,073.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,570.40 / $4,570.88 / $6,456.54
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,248.07 / $5,248.07 / $5,248.07
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,162.28 / $5,248.07 / $6,025.60
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,691.53 / $2,754.23 / $3,235.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,398.83 / $3,548.13 / $5,623.41