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Hawaii rates for HCPCS L6638

Upper extremity addition to prosthesis, electric locking feature, only for use with manually powered elbow

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,082.82 / $1,082.82 / $1,082.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,340.78 / $2,340.78 / $2,340.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,952.91 / $1,952.91 / $3,241.22
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,946.56 / $3,085.40 / $3,085.40
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,767.94 / $2,946.56 / $4,125.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,053.46 / $2,340.78 / $3,241.22
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,373.57 / $2,454.91 / $2,804.58