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Idaho rates for HCPCS L1755

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$932.33 / $1,561.84 / $1,561.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,395.53 / $1,395.53 / $1,484.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,018.74 / $1,018.74 / $1,872.85
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$574.47 / $1,256.42 / $1,783.67
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,605.30 / $1,694.49 / $1,783.67
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $1,316.34 / $1,567.68
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,561.84 / $1,741.87 / $2,612.81
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,248.57 / $1,248.57 / $1,872.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$822.74 / $889.85 / $1,396.02