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North Carolina 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
$138.63 / $138.63 / $239.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.91 / $138.63 / $138.63
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.74 / $130.59 / $142.49
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$126.93 / $152.31 / $289.22
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.22 / $118.74 / $130.61
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 / $182.63
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.29 / $138.63 / $180.22
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.00 / $89.00 / $107.64
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$184.30 / $184.30 / $283.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.47 / $78.98 / $123.91
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$247.38 / $734.34 / $734.34
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$792.37 / $792.37 / $1,152.08