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Hawaii rates for HCPCS L1830

Knee orthosis (KO), immobilizer, canvas longitudinal, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.81 / $39.81 / $39.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $51.29 / $58.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.61 / $67.61 / $173.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.61 / $131.83 / $186.21
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $181.97 / $190.55
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $151.36 / $173.78
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.98 / $48.98 / $61.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.48 / $138.04 / $173.78