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New Hampshire rates for HCPCS L1755

Legg Perthes Orthotic, (Patten Bottom Type), Custom Fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,339.10 / $1,339.10 / $1,606.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$832.75 / $1,039.10 / $1,339.10
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,378.23 / $2,378.23 / $2,819.15
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,086.33 / $1,086.33 / $1,138.23
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 / $1,395.53
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,925.54 / $1,925.54 / $5,943.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$790.98 / $1,186.47 / $1,999.01
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,781.21 / $1,959.33 / $2,493.69