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Tennessee 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
$71.23 / $71.23 / $77.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.84 / $73.47 / $133.32
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.74 / $118.74 / $118.74
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.33 / $142.49 / $142.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$82.11 / $88.85 / $88.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.86 / $64.86 / $88.85
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$247.38 / $734.34 / $734.34
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$792.37 / $792.37 / $1,152.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.66 / $75.69 / $105.69