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Alaska rates for HCPCS L2755

Addition to lower extremity orthosis, high strength, lightweight material, all hybrid lamination/prepreg composite, per segment, for custom fabricated orthosis only

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.84 / $132.94 / $132.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$88.85 / $88.85 / $88.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.86 / $88.85 / $94.72
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.29 / $45.29 / $45.29
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$146.00 / $147.43 / $232.79
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.29 / $45.29 / $88.85
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.86 / $94.72 / $151.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.01 / $148.40 / $193.56