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Maine rates for HCPCS L1755

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,039.10 / $1,443.54 / $1,443.54
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,115.19 / $2,740.43 / $5,079.89
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,086.33 / $1,138.23 / $1,138.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,395.53 / $1,395.53 / $1,747.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,018.74 / $1,018.74 / $1,395.53
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,925.54 / $1,925.54 / $1,925.54
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,339.10 / $1,443.54 / $1,443.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$790.98 / $1,186.47 / $2,728.51