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Washington rates for HCPCS L1620

Hip orthosis (HO), abduction control of hip joints, flexible, (Pavlik harness), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise

Facilitymedian $162 · 10th–90th $107–$4570%10%10th90th$162Professionalmedian $107 · 10th–90th $74–$2820%10%10th90th$107$1.0$5.0$20.0$100.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$107.15 / $562.34 / $588.84
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $93.33 / $173.78
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$138.04 / $154.88 / $154.88
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $138.04 / $177.83
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$117.49 / $117.49 / $125.89
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$85.11 / $85.11 / $117.49
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$95.50 / $213.80 / $446.68
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $194.98 / $346.74
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $123.03 / $134.90
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$125.89 / $154.88 / $158.49
Pacific Source
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $151.36 / $173.78
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$138.04 / $234.42 / $316.23
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $131.83 / $154.88
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$154.88 / $154.88 / $154.88
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $138.04 / $177.83
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$74.13 / $204.17 / $245.47
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $81.28 / $144.54
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$46.77 / $138.04 / $245.47