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Indiana 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
$77.92 / $77.92 / $157.43
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.92 / $79.37 / $84.56
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.20 / $110.20 / $110.20
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$124.37 / $140.90 / $157.43
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.80 / $84.87 / $117.12
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$118.74 / $173.17 / $236.15
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$133.82 / $173.17 / $212.53
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$88.85 / $88.85 / $157.43
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.86 / $88.85 / $161.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.77 / $76.00 / $106.45