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Arizona 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
$61.47 / $78.36 / $138.63
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.26 / $115.26 / $130.63
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.34 / $145.74 / $263.50
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.87 / $134.49 / $176.52
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 / $64.86 / $182.63
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.29 / $107.10 / $734.34
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.35 / $70.16 / $105.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.35 / $70.16 / $105.69