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Georgia rates for HCPCS L1630

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$92.29 / $92.29 / $219.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.59 / $119.82 / $145.36
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.36 / $272.10 / $713.30
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.61 / $161.60 / $310.27
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.27 / $216.35 / $359.57
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.21 / $165.21 / $165.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$119.29 / $119.29 / $119.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.08 / $87.08 / $295.13
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.71 / $194.36 / $287.77
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$240.29 / $242.95 / $247.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.64 / $96.96 / $168.17