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Louisiana 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
$85.56 / $90.82 / $122.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.18 / $90.82 / $98.72
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.15 / $117.15 / $117.15
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$137.79 / $235.39 / $330.88
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.97 / $112.40 / $112.40
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$124.76 / $124.76 / $124.76
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 / $88.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.77 / $73.03 / $108.11