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Montana rates for HCPCS L1755

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$932.33 / $6,826.77 / $6,826.77
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,395.53 / $1,872.85 / $1,872.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,340.43 / $1,872.85 / $1,872.85
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$994.43 / $1,783.67 / $1,872.85
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,405.66 / $1,436.81 / $1,952.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$804.26 / $889.85 / $1,361.71