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Hawaii rates for HCPCS L0641

Lumbar orthosis (LO), sagittal control, with rigid posterior panel(s), posterior extends from L-1 to below L-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.53 / $52.53 / $52.53
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.81 / $72.81 / $72.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.17 / $52.17 / $95.78
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.07 / $91.17 / $91.17
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.95 / $87.07 / $121.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.48 / $81.41 / $95.78
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.83 / $76.36 / $83.66