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Hawaii rates for HCPCS L5968

Addition to lower limb prosthesis, multiaxial ankle with swing phase active dorsiflexion feature

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,573.49 / $1,573.49 / $1,573.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,401.49 / $3,401.49 / $3,401.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,448.80 / $2,448.80 / $4,709.95
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,281.77 / $4,483.53 / $4,483.53
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,569.06 / $4,281.77 / $5,994.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,983.98 / $3,401.49 / $4,709.95
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,872.56 / $3,449.13 / $4,075.46