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Massachusetts rates for HCPCS L1755

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,039.10 / $1,039.10 / $1,039.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,039.10 / $1,039.10 / $1,339.10
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,332.27 / $4,379.32 / $11,238.98
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$871.28 / $1,430.15 / $2,322.48
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,524.23 / $3,071.02 / $3,954.90
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,557.28 / $1,833.41 / $1,833.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,375.61 / $1,395.53 / $1,667.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,018.74 / $1,018.74 / $2,500.88
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,925.54 / $1,925.54 / $2,021.82
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,180.60 / $1,180.60 / $1,180.60
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,379.32 / $11,238.98 / $11,238.98
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$790.98 / $1,186.47 / $2,322.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$804.26 / $1,186.47 / $1,992.46