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Nebraska rates for HCPCS L1755

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,163.92 / $1,163.92 / $1,163.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,163.92 / $1,163.92 / $1,511.36
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,604.11 / $1,764.54 / $1,782.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,395.53 / $2,007.65 / $2,007.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,952.95 / $2,345.21 / $3,126.09
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,080.81 / $2,001.77 / $9,370.62
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$685.62 / $910.54 / $1,517.56
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,001.77 / $2,007.65 / $2,709.67
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,815.00 / $2,372.67 / $4,136.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$685.62 / $910.54 / $1,371.23