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Pennsylvania 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

Facilitymedian $245 · 10th–90th $81–$5370%20%10th90th$245Professionalmedian $107 · 10th–90th $81–$2190%20%10th90th$107$0.2$2.0$20.0$200.0$2.0K$20.0K

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
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$81.28 / $316.23 / $537.03
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $107.15 / $218.78
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$154.88 / $154.88 / $154.88
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,011.87 / $8,511.38 / $77,624.71
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$199.53 / $199.53 / $199.53
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$112.20 / $112.20 / $177.83
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $83.18 / $114.82
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$186.21 / $263.03 / $380.19
Geisinger
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$199.53 / $199.53 / $199.53
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $141.25 / $199.53
Highmark BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $158.49 / $165.96
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$81.28 / $81.28 / $537.03
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $104.71 / $181.97
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$66.07 / $66.07 / $309.03
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$138.04 / $141.25 / $186.21
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $141.25 / $190.55
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$89.13 / $245.47 / $281.84
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $97.72 / $199.53