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Hawaii rates for HCPCS L5782

Addition to lower limb prosthesis, vacuum pump, residual limb volume management and moisture evacuation system, heavy-duty

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,137.96 / $2,691.53 / $4,265.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,311.31 / $3,311.31 / $3,981.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,311.31 / $4,466.84 / $6,309.57
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,011.87 / $5,011.87 / $5,248.07
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,019.95 / $5,011.87 / $5,888.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,019.95 / $3,090.30 / $3,630.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,691.53 / $3,801.89 / $5,495.41