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Michigan 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
$89.90 / $89.90 / $217.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.65 / $89.90 / $89.90
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$238.28 / $474.75 / $864.67
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$149.56 / $157.43 / $212.53
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.86 / $102.33 / $102.91
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.94 / $125.94 / $125.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$88.85 / $88.85 / $88.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.85 / $88.85 / $182.63
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.90 / $113.76 / $217.62
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.49 / $113.76 / $165.30
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.81 / $30.00 / $30.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.94 / $73.93 / $111.27