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Hawaii rates for HCPCS L5705

Custom shaped protective cover, above knee (AK)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$459.94 / $459.94 / $459.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$985.99 / $985.99 / $985.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$895.43 / $895.43 / $1,365.29
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,241.17 / $1,299.65 / $1,299.65
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$744.70 / $1,241.17 / $1,737.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.18 / $985.99 / $1,365.29
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$542.80 / $999.80 / $1,181.35