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Missouri 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
$109.41 / $109.41 / $145.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.41 / $113.39 / $173.07
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$209.00 / $219.45 / $964.74
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.80 / $116.28 / $169.09
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 / $87.08
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$103.17 / $169.17 / $980.51
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.90 / $104.27 / $254.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.90 / $104.27 / $153.62