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Minnesota 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
$109.38 / $109.38 / $109.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.70 / $109.38 / $115.76
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.86 / $157.43 / $219.21
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.94 / $149.56 / $157.43
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$88.85 / $486.24 / $1,350.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$182.63 / $193.58 / $231.93
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.67 / $466.52 / $1,063.38
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$182.63 / $182.63 / $188.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.65 / $157.43 / $734.34
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.47 / $84.80 / $158.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.77 / $78.34 / $172.50