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Hawaii rates for HCPCS L8417

Prosthetic sheath/sock, including a gel cushion layer, below knee (BK) or above knee (AK), each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.51 / $32.51 / $32.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$76.03 / $76.03 / $76.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.66 / $50.66 / $105.28
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.71 / $100.22 / $100.22
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.43 / $95.71 / $133.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.89 / $76.03 / $105.28
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.85 / $59.79 / $91.10