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Hawaii rates for HCPCS L5857

Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing phase only, includes electronic sensor(s), any type

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,735.50 / $3,735.50 / $3,735.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,379.24 / $8,379.24 / $8,379.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,652.12 / $6,652.12 / $11,602.50
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,547.73 / $11,044.74 / $11,044.74
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,383.41 / $10,547.73 / $14,766.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,041.76 / $8,379.24 / $11,602.50
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,496.59 / $8,787.78 / $10,039.49