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Hawaii rates for HCPCS L1210

Addition to thoracic-lumbar-sacral orthosis (TLSO), (low profile), lateral thoracic extension

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $169.82 / $204.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.55 / $190.55 / $371.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $416.87 / $588.84
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $478.63 / $501.19
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $478.63 / $549.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.54 / $181.97 / $186.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $323.59 / $512.86