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Hawaii rates for HCPCS L5990

Addition to lower extremity prosthesis, user adjustable heel height

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$785.55 / $785.55 / $785.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,698.18 / $1,698.18 / $1,698.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,222.54 / $2,351.42 / $2,351.42
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,137.66 / $2,238.39 / $2,238.39
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,496.36 / $2,137.66 / $2,992.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,489.73 / $1,698.18 / $2,351.42
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,489.73 / $1,780.98 / $2,034.66