go back

Louisiana 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
$81.58 / $86.60 / $116.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.58 / $86.60 / $109.82
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$131.38 / $224.45 / $315.49
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.59 / $107.17 / $107.17
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
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 / $126.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.20 / $71.66 / $115.23