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Hawaii rates for HCPCS L5858

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,047.40 / $8,047.40 / $8,047.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17,396.43 / $17,396.43 / $17,396.43
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14,513.81 / $14,513.81 / $24,088.35
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21,898.50 / $22,930.36 / $22,930.36
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,328.95 / $21,898.50 / $30,657.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13,290.56 / $17,396.43 / $24,088.35
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17,640.06 / $18,244.61 / $20,843.32