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Kentucky 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
$100.00 / $100.00 / $102.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $114.82 / $169.82
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.83 / $199.53 / $208.93
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $112.20 / $123.03
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.54 / $263.03 / $338.84
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.98 / $245.47 / $309.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.23 / $338.84 / $338.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $177.83 / $1,000.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $128.82 / $165.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.33 / $102.33 / $120.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $97.72 / $154.88