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Rhode Island 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
$50.06 / $90.65 / $105.31
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$251.06 / $339.11 / $401.47
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.98 / $99.98 / $160.59
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 / $126.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.82 / $88.59 / $147.65