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Idaho 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 / $123.03 / $181.97
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.18 / $199.53 / $331.13
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.78 / $229.09 / $229.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.23 / $120.23 / $128.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $87.10 / $120.23
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.66 / $173.78 / $229.09
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $199.53 / $208.93
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $177.83
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.98 / $199.53 / $199.53
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $147.91 / $229.09
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $208.93 / $208.93
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.33 / $104.71 / $125.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $95.50 / $134.90