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Minnesota 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
$131.54 / $131.54 / $131.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.06 / $90.65 / $131.54
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.16 / $189.31 / $263.63
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.44 / $179.84 / $189.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.36 / $578.87 / $1,355.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$219.38 / $232.54 / $278.61
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$347.02 / $560.82 / $1,278.31
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$219.38 / $219.38 / $226.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.07 / $189.31 / $791.34
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.20 / $83.33 / $190.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.20 / $84.25 / $243.83