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New Mexico rates for HCPCS L1755

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$874.63 / $874.63 / $874.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$874.63 / $1,343.18 / $6,826.77
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 / $2,650.93
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,426.93 / $1,783.67 / $2,675.50
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$574.47 / $574.47 / $1,395.53
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,018.74 / $1,395.53 / $2,090.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$807.98 / $889.85 / $1,340.43