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Wisconsin rates for HCPCS L1630

Hip orthosis (HO), abduction control of hip joints, semi-flexible (Von Rosen type), custom fabricated

Facilitymedian $257 · 10th–90th $209$4680%50%10th90th$257Professionalmedian $145 · 10th–90th $89$3890%20%10th90th$145$0.2$1.0$5.0$20.0$100.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$128.82 / $128.82 / $128.82
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$85.11 / $128.82 / $173.78
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$257.04 / $257.04 / $426.58
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$234.42 / $239.88 / $288.40
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$120.23 / $602.56 / $1,288.25
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $371.54 / $489.78
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$128.82 / $208.93 / $323.59
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$144.54 / $229.09 / $309.03
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$128.82 / $257.04 / $977.24
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $125.89 / $275.42
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $70.79 / $138.04
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$407.38 / $407.38 / $407.38
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $295.12 / $512.86
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$257.04 / $389.05 / $602.56
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$120.23 / $512.86 / $977.24
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $173.78 / $1,148.15
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$74.13 / $112.20 / $257.04
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$85.11 / $125.89 / $208.93