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Missouri 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
$82.01 / $82.01 / $109.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.91 / $84.99 / $129.72
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.96 / $104.96 / $117.49
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$156.65 / $164.48 / $723.10
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.29 / $84.87 / $126.74
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 / $64.86 / $94.72
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$78.41 / $126.80 / $734.34
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.13 / $78.15 / $190.41
Qualchoice
Facility/Professional
Professional
Modifier
Low / Median / High Price
$145.65 / $145.65 / $145.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.94 / $78.15 / $118.97