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Hawaii rates for HCPCS L1250

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.67 / $48.98 / $66.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.66 / $61.66 / $87.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $97.72 / $138.04
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $112.20 / $117.49
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.61 / $112.20 / $128.82
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.81 / $51.29 / $52.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.86 / $75.86 / $120.23