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Minnesota rates for HCPCS L1755

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,498.95 / $1,498.95 / $1,498.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$853.24 / $1,498.95 / $1,498.95
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,848.02 / $2,157.30 / $3,003.98
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,725.84 / $2,049.44 / $2,157.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,395.53 / $6,656.29 / $18,487.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,500.88 / $2,650.93 / $3,176.11
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,951.76 / $6,386.39 / $14,556.93
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,500.88 / $2,500.88 / $2,573.60
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$591.70 / $2,157.30 / $9,370.62
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$593.24 / $915.92 / $2,166.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$593.24 / $993.67 / $3,706.93