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Maine 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
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.36 / $125.14 / $125.14
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$183.36 / $237.56 / $440.36
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.27 / $115.06 / $115.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.67 / $112.67 / $151.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.25 / $82.25 / $112.67
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.92 / $166.92 / $166.92
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.29 / $125.14 / $125.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.56 / $102.85 / $236.52