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Arkansas rates for HCPCS L1620

Hip Orthosis Abduction Control Of Hip Joints Flexible (Pavlik Harness) Prefabricated Item That Has Been Trimmed Bent Molded Assembled Orotherwise Customized To Fit A Specific Patient By An Individual With Expertise (Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.90 / $83.90 / $83.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.48 / $83.90 / $90.65
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$219,999.78 / $539,999.46 / $949,999.05
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.30 / $172.46 / $191.62
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.87 / $162.87 / $181.44
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.44 / $181.44 / $181.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.36 / $117.36 / $126.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.67 / $117.36 / $117.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.20 / $71.95 / $100.86