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Alaska rates for HCPCS L1755

Legg Perthes orthosis, (Patten bottom type), custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,057.13 / $2,057.13 / $2,057.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,395.53 / $1,395.53 / $1,395.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,018.74 / $1,018.74 / $1,018.74
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$574.47 / $574.47 / $574.47
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,694.49 / $2,281.34 / $3,602.12
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$574.47 / $574.47 / $1,395.53
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,018.74 / $1,322.87 / $2,252.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,160.66 / $2,296.23 / $2,995.10