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Oregon 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
Professional
Modifier
Low / Median / High Price
$74.67 / $95.39 / $540.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.36 / $117.36 / $117.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.67 / $85.67 / $117.36
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.32 / $319.58 / $416.83
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.39 / $130.68 / $159.03
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.25 / $149.49 / $166.98
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$126.24 / $150.94 / $168.57
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$143.13 / $159.03 / $174.93
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.39 / $136.41 / $166.98
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.67 / $139.25 / $174.93
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$132.49 / $264.45 / $557.91
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.77 / $174.93 / $174.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.88 / $75.31 / $143.66