go back

Arizona 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
Professional
Modifier
Low / Median / High Price
$74.86 / $90.65 / $142.61
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.14 / $177.50 / $320.92
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.84 / $163.78 / $223.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.36 / $117.36 / $117.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.67 / $85.67 / $219.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.61 / $125.04 / $791.34
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.98 / $75.31 / $113.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.06 / $75.31 / $113.43