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Hawaii rates for HCPCS L6930

Below elbow, external power, self-suspended inner socket, removable forearm shell, Otto Bock or equal switch, cables, two batteries and one charger, switch control of terminal device

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,961.85 / $2,961.85 / $2,961.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,114.58 / $7,114.58 / $7,114.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,300.68 / $6,300.68 / $9,851.34
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,955.76 / $9,377.76 / $9,377.76
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,373.46 / $8,955.76 / $12,538.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,153.10 / $7,114.58 / $9,851.34
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,916.68 / $7,214.21 / $8,524.23