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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
$1,174.90 / $1,174.90 / $1,174.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,174.90 / $10,232.93
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,621.81 / $1,778.28 / $1,778.28
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,380.38 / $1,380.38 / $2,041.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $2,398.83 / $3,388.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,174.90 / $2,041.74 / $9,332.54
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $912.01 / $1,819.70
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,995.26 / $1,995.26 / $4,570.88
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,041.74 / $2,041.74 / $2,041.74
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,511.89 / $4,570.88 / $4,570.88
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$691.83 / $1,047.13 / $2,041.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $912.01 / $1,412.54