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Massachusetts 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
$77.58 / $77.58 / $155.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.87 / $77.58 / $101.68
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$90.77 / $384.30 / $889.01
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.37 / $119.43 / $173.42
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$188.47 / $229.30 / $295.29
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.28 / $128.08 / $128.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.71 / $117.36 / $126.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.67 / $117.36 / $219.38
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$143.78 / $143.78 / $150.97
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.47 / $103.47 / $103.47
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$384.30 / $889.01 / $889.01
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.76 / $88.59 / $173.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.61 / $89.57 / $167.02