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Vermont 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
$79.43 / $120.23 / $144.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.23 / $120.23 / $186.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $87.10 / $123.03
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $199.53 / $257.04
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.33 / $95.50 / $120.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $151.36 / $524.81