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Virginia 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
$62.88 / $75.95 / $75.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.88 / $75.95 / $92.90
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$153.63 / $153.63 / $163.16
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.87 / $84.87 / $109.41
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.77 / $85.77 / $105.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$82.13 / $88.85 / $88.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.86 / $64.86 / $88.85
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.54 / $138.27 / $184.36
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.29 / $89.92 / $171.67
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.00 / $192.04 / $255.90
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$88.62 / $116.47 / $192.04
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.62 / $116.47 / $192.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.71 / $76.64 / $115.16