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North Carolina 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
$169.82 / $169.82 / $169.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.18 / $128.82 / $169.82
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.18 / $190.55 / $389.05
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $147.91 / $162.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.10 / $120.23 / $120.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $87.10 / $154.88
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $95.50 / $128.82
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.18 / $169.82 / $288.40
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $0.60 / $0.60
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.57 / $95.50 / $154.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $95.50 / $144.54
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$977.24 / $977.24 / $977.24
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $1,148.15 / $1,445.44