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Hawaii rates for HCPCS L1220

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.29 / $113.29 / $113.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$323.45 / $323.45 / $323.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$185.61 / $185.61 / $447.90
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.18 / $426.37 / $426.37
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$244.31 / $407.18 / $570.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.97 / $323.45 / $447.90
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$178.07 / $328.00 / $387.56