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Lower Extremity Orthosis Addition, Lightweight Composite

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

Rates data updated July 2026.

Facilitymedian $148 · 10th–90th $107$2190%10%10th90th$148Professionalmedian $135 · 10th–90th $93$2290%10%20%10th90th$135$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
Setting
Facility
Modifier
Global
Typical Low
$114.82
Median
$114.82
Typical High
$114.82
Aetna
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$109.65
Typical High
$134.90
Avera
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$169.82
Typical High
$173.78
Cigna
Setting
Facility
Modifier
Global
Typical Low
$89.13
Median
$89.13
Typical High
$173.78
Cigna
Setting
Professional
Modifier
Global
Typical Low
$181.97
Median
$181.97
Typical High
$229.09
Medica
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$154.88
Typical High
$295.12
Medica
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$104.71
Typical High
$794.33
Midlands
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$173.78
Typical High
$173.78
Midlands
Setting
Facility
Modifier
Global
Typical Low
$173.78
Median
$173.78
Typical High
$173.78
Midlands
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$144.54
Typical High
$288.40
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$158.49
Typical High
$208.93
United
Setting
Facility
Modifier
Global
Typical Low
$77.62
Median
$81.28
Typical High
$117.49
United
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$107.15
Typical High
$186.21
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$154.88
Typical High
$154.88