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Oklahoma rates for HCPCS L1755

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$851.14 / $851.14 / $851.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $1,000.00 / $1,513.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,380.38 / $1,380.38 / $1,380.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,023.29 / $1,995.26
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $1,174.90 / $5,495.41
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $891.25 / $2,238.72
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $1,412.54 / $2,041.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $851.14 / $1,288.25