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Utah rates for HCPCS L1755

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$574.47 / $574.47 / $574.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$574.47 / $796.54 / $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 / $2,525.88
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$807.31 / $1,302.11 / $1,692.75
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,561.84 / $1,741.87 / $1,741.87
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$991.88 / $1,248.57 / $1,872.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$683.67 / $881.92 / $1,070.20