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Georgia 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
Facility
Modifier
Low / Median / High Price
$75.18 / $75.18 / $178.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.47 / $92.90 / $140.00
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.16 / $117.16 / $237.48
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$158.32 / $221.65 / $581.03
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.40 / $131.63 / $252.75
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$130.59 / $134.57 / $292.89
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.57 / $134.57 / $134.57
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 / $182.63
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.32 / $158.32 / $219.91
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$195.74 / $197.90 / $201.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.66 / $78.98 / $130.31