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Illinois 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
$97.30 / $97.30 / $164.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.73 / $97.30 / $139.25
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$225.78 / $381.98 / $1,628.92
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.44 / $143.88 / $143.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.36 / $117.36 / $171.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.67 / $117.36 / $219.38
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$155.51 / $200.00 / $240.07
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$246.10 / $246.10 / $246.10
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.88 / $152.69 / $160.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.76 / $91.51 / $162.13