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Lower Extremity Orthosis Addition, Lightweight Composite

Washington 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 $155 · 10th–90th $105$3240%20%10th90th$155Professionalmedian $129 · 10th–90th $71$2630%10%20%10th90th$129$2.0$10.0$50.0$200.0$1.0K

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

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$51.29
Median
$104.71
Typical High
$245.47
Aetna
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$104.71
Typical High
$245.47
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$141.25
Typical High
$141.25
Asuris Northwest Health
Setting
Facility
Modifier
Global
Typical Low
$147.91
Median
$151.36
Typical High
$154.88
Asuris Northwest Health
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$131.83
Typical High
$173.78
Cigna
Setting
Facility
Modifier
Global
Typical Low
$89.13
Median
$89.13
Typical High
$89.13
Cigna
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$64.57
Typical High
$89.13
Kaiser Permanente
Setting
Facility
Modifier
Global
Typical Low
$97.72
Median
$199.53
Typical High
$436.52
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$181.97
Typical High
$323.59
Molina
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$107.15
Typical High
$128.82
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$123.03
Median
$151.36
Typical High
$154.88
Pacific Source
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$154.88
Typical High
$173.78
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$134.90
Median
$223.87
Typical High
$309.03
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$128.82
Typical High
$151.36
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$151.36
Median
$151.36
Typical High
$154.88
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$131.83
Typical High
$173.78
United
Setting
Facility
Modifier
Global
Typical Low
$69.18
Median
$229.09
Typical High
$229.09
United
Setting
Professional
Modifier
Global
Typical Low
$66.07
Median
$77.62
Typical High
$134.90
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$131.83
Typical High
$234.42