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Idaho 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
$60.56 / $115.76 / $134.57
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$88.85 / $88.85 / $96.39
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 / $108.25 / $153.68
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.31 / $146.00 / $153.68
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $113.41 / $135.07
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.57 / $150.08 / $225.12
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.58 / $111.38 / $161.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.87 / $70.16 / $108.11