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Indiana 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
$125.98 / $125.98 / $254.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.62 / $125.98 / $136.71
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$201.08 / $227.80 / $254.53
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.80 / $116.28 / $160.46
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.44 / $267.26 / $356.34
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$216.35 / $279.98 / $343.62
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$119.29 / $119.29 / $254.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.08 / $87.08 / $261.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.49 / $119.53 / $170.08