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Indiana 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
$93.70 / $93.70 / $189.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.94 / $93.70 / $101.68
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$149.55 / $169.43 / $189.31
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.39 / $94.06 / $129.80
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.44 / $203.59 / $265.02
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.91 / $208.24 / $255.57
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.36 / $117.36 / $189.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.67 / $117.36 / $171.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.20 / $88.91 / $120.94