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West Virginia 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
$93.74 / $93.74 / $93.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.61 / $89.71 / $93.74
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.94 / $226.80 / $317.52
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.01 / $127.01 / $195.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.36 / $117.36 / $194.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.67 / $117.36 / $815.01
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.53 / $122.53 / $122.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.11 / $90.52 / $150.87