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Hawaii rates for HCPCS L5781

Addition To Lower Limb Prosthesis Vacuum Pump Residual Limb Volume Management And Moisture Evacuation System

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,732.50 / $1,732.50 / $1,732.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,745.23 / $3,745.23 / $3,745.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,886.72 / $2,886.72 / $5,185.93
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,714.47 / $4,936.63 / $4,936.63
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,828.69 / $4,714.47 / $6,600.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,861.31 / $3,745.23 / $5,185.93
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,285.53 / $3,927.84 / $4,487.31