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Arizona rates for HCPCS L1630

Hip orthosis (HO), abduction control of hip joints, semi-flexible (Von Rosen type), custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.18 / $114.82 / $512.86
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $125.89 / $263.03
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.49 / $208.93 / $398.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.23 / $120.23 / $120.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $87.10 / $120.23
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.66 / $144.54 / $977.24
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $95.50 / $1,122.02
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.44 / $123.03 / $165.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $95.50 / $144.54