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Indiana rates for HCPCS L1755

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,067.74 / $1,067.74 / $2,157.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$990.49 / $1,067.74 / $1,158.71
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,704.27 / $1,930.78 / $2,157.30
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,044.49 / $1,086.33 / $1,499.14
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,579.53 / $2,322.84 / $3,020.22
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,833.71 / $2,373.03 / $2,912.36
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,395.53 / $1,395.53 / $2,157.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,018.74 / $1,018.74 / $2,212.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$593.24 / $1,031.33 / $1,378.04