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New York 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
$52.29 / $66.84 / $123.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.29 / $67.11 / $96.85
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$153.61 / $156.68 / $307.22
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.87 / $84.87 / $237.63
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$119.02 / $127.98 / $127.98
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.98 / $127.98 / $127.98
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 / $88.85
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$153.61 / $319.00 / $345.62
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.31 / $113.67 / $276.50
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.60 / $60.60 / $60.60
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.60 / $92.35 / $110.14
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.58 / $124.58 / $124.58
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$88.85 / $88.85 / $555.00
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.86 / $88.85 / $228.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.09 / $81.01 / $140.49
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$92.35 / $92.35 / $95.96
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.60 / $92.35 / $98.12