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Nationwide rates for HCPCS L4396

Static Or Dynamic Ankle Foot Orthosis Including Soft Interface Material Adjustable For Fit For Positioning May Be Used For Minimal Ambulation Prefabricated Item That Has Been Trimmed Bent Molded Assembled Or Otherwise Customized To Fit A Specific Patient By An Individual With Expertise(Revised 01/01/14)

Insurance Carrier	Facility/Professional	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $100.13 / $104.21 / $139.90	Facility	$100.13	$104.21	$139.90
Aetna Facility/Professional Professional Modifier Low / Median / High Price $87.24 / $108.29 / $161.04	Professional	$87.24	$108.29	$161.04
BCBS Facility/Professional Facility Modifier Low / Median / High Price $194.02 / $206.16 / $394.62	Facility	$194.02	$206.16	$394.62
BCBS Facility/Professional Professional Modifier Low / Median / High Price $107.10 / $109.27 / $155.34	Professional	$107.10	$109.27	$155.34
Cigna Facility/Professional Facility Modifier Low / Median / High Price $112.67 / $112.67 / $119.14	Facility	$112.67	$112.67	$119.14
Cigna Facility/Professional Professional Modifier Low / Median / High Price $82.25 / $112.67 / $120.11	Professional	$82.25	$112.67	$120.11
United Facility/Professional Professional Modifier Low / Median / High Price $73.87 / $97.45 / $148.29	Professional	$73.87	$97.45	$148.29

Nationwide rates for HCPCS L4396

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