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Maryland rates for HCPCS L1755

Legg Perthes Orthotic, (Patten Bottom Type), Custom Fabricated

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$828.16 / $882.48 / $1,581.79
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,085.00 / $1,085.00 / $1,383.21
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,416.41 / $2,023.44 / $2,913.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$804.26 / $1,009.48 / $1,609.09
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,068.58 / $1,068.58 / $1,416.41