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Oklahoma 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
$74.84 / $74.84 / $110.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.08 / $74.84 / $84.46
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.74 / $118.74 / $118.74
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.62 / $138.62 / $138.62
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
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.29 / $96.39 / $734.34
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.77 / $75.45 / $156.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.77 / $70.16 / $100.65