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South Dakota 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

Facilitymedian $120 · 10th–90th $110$1950%20%40%10th90th$120Professionalmedian $110 · 10th–90th $71$2090%20%10th90th$110$50.0$100.0$200.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$109.65 / $109.65 / $109.65
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $107.15 / $134.90
Avera
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$169.82 / $169.82 / $173.78
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$89.13 / $89.13 / $173.78
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $181.97 / $229.09
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$120.23 / $154.88 / $295.12
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $104.71 / $794.33
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$144.54 / $173.78 / $173.78
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$173.78 / $173.78 / $173.78
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$144.54 / $144.54 / $288.40
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $158.49 / $208.93
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $107.15 / $177.83
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$154.88 / $154.88 / $154.88