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Wisconsin rates for HCPCS L1755

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,088.28 / $1,088.28 / $1,088.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$882.48 / $1,088.28 / $1,675.99
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,157.30 / $2,373.03 / $3,926.29
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,006.29 / $2,006.29 / $2,653.47
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,551.96 / $4,616.62 / $4,616.62
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,395.53 / $4,459.63 / $9,004.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,018.74 / $3,592.92 / $4,082.86
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$574.47 / $1,632.42 / $2,480.90
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,235.22 / $2,157.30 / $2,588.76
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$994.43 / $2,157.30 / $9,370.62
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$859.44 / $1,076.26 / $2,349.03
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $1,311.13
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$574.47 / $1,632.42 / $2,480.90
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,235.22 / $2,157.30 / $2,588.76
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,157.30 / $3,320.01 / $5,339.68
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,395.53 / $4,213.47 / $9,370.62
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,018.74 / $1,395.53 / $11,357.28
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,157.30 / $2,157.30 / $2,157.30
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,157.30 / $2,157.30 / $2,157.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$717.50 / $1,076.26 / $1,912.70