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Hawaii rates for HCPCS L6624

Upper extremity addition, flexion/extension and rotation wrist unit

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,630.72 / $1,630.72 / $1,630.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,525.22 / $3,525.22 / $3,525.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,941.06 / $4,881.27 / $4,881.27
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,437.52 / $4,646.62 / $4,646.62
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,662.51 / $4,437.52 / $6,212.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,379.79 / $3,525.22 / $4,881.27
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,574.59 / $3,697.10 / $4,223.70