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New Mexico 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
$77.63 / $77.63 / $77.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.63 / $119.21 / $443.40
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$229.55 / $778.09 / $1,377.53
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.85 / $126.46 / $150.68
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
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.81 / $158.31 / $221.63
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.29 / $45.29 / $118.97
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.86 / $88.85 / $180.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.71 / $70.16 / $105.69