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North Carolina rates for HCPCS L1755

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,627.17 / $1,627.17 / $2,806.97
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$832.75 / $1,627.17 / $1,627.17
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,692.87 / $2,756.48 / $3,394.68
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,293.73 / $1,393.70 / $1,533.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,149.48 / $1,395.53 / $1,395.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$919.58 / $1,018.74 / $2,500.88
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$574.47 / $1,627.17 / $2,115.32
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,045.00 / $1,045.00 / $1,263.50
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,203.10 / $2,203.10 / $3,387.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.49 / $927.07 / $1,350.12
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,003.41 / $11,238.98 / $11,238.98
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11,357.28 / $11,357.28 / $13,769.33