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Missouri rates for HCPCS L1755

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$955.45 / $955.45 / $1,272.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$955.45 / $990.20 / $1,511.36
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,825.14 / $1,916.40 / $8,424.85
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,015.03 / $1,086.33 / $1,476.61
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
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$955.45 / $1,477.28 / $9,370.62
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$737.24 / $910.54 / $2,218.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$694.88 / $910.54 / $1,371.23