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Vermont 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 / $86.65 / $99.98
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$143.68 / $143.68 / $143.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.36 / $117.36 / $130.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.67 / $117.36 / $120.88
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.36 / $117.36 / $130.51
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.67 / $117.36 / $126.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.42 / $133.44 / $205.27