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Iowa 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
$138.88 / $176.86 / $176.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.56 / $129.54 / $175.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$119.29 / $119.29 / $229.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.90 / $295.13 / $368.91
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.36 / $216.35 / $254.53
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$131.29 / $268.56 / $980.51
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.24 / $110.07 / $285.56
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$229.22 / $229.90 / $290.02
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$188.28 / $268.56 / $439.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.39 / $104.27 / $245.82
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$204.82 / $204.82 / $204.82
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.81 / $204.82 / $204.82