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Vermont 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
Professional
Modifier
Low / Median / High Price
$64.57 / $83.18 / $93.33
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $123.03 / $123.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.13 / $89.13 / $112.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $64.57 / $89.13
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $151.36 / $186.21
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.18 / $77.62 / $87.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.70 / $107.15 / $323.59