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Lower Extremity Orthosis Addition, Lightweight Composite

Wisconsin 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 $162 · 10th–90th $120$3240%50%10th90th$162Professionalmedian $148 · 10th–90th $79$2690%20%10th90th$148$0.1$0.5$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
$79.43
Median
$79.43
Typical High
$79.43
Aetna
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$79.43
Typical High
$138.04
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$162.18
Median
$162.18
Typical High
$263.03
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$147.91
Typical High
$177.83
Cigna
Setting
Facility
Modifier
Global
Typical Low
$89.13
Median
$371.54
Typical High
$812.83
Cigna
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$234.42
Typical High
$302.00
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$79.43
Median
$128.82
Typical High
$199.53
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$190.55
Typical High
$234.42
Medica
Setting
Facility
Modifier
Global
Typical Low
$79.43
Median
$158.49
Typical High
$741.31
Medica
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$83.18
Typical High
$173.78
Molina
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$70.79
Typical High
$102.33
Network Health
Setting
Facility
Modifier
Global
Typical Low
$251.19
Median
$251.19
Typical High
$251.19
Network Health
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$181.97
Typical High
$316.23
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$79.43
Median
$128.82
Typical High
$199.53
Prevea360
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$154.88
Typical High
$158.49
Quartz
Setting
Professional
Modifier
Global
Typical Low
$162.18
Median
$239.88
Typical High
$416.87
Quartz
Setting
Facility
Modifier
Global
Typical Low
$89.13
Median
$323.59
Typical High
$741.31
Quartz
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$239.88
Typical High
$812.83
Security Health
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$144.54
Typical High
$147.91
United
Setting
Facility
Modifier
Global
Typical Low
$53.70
Median
$81.28
Typical High
$162.18
United
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$79.43
Typical High
$144.54