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Utah 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 $63 · 10th–90th $58–$2000%20%40%10th90th$63Professionalmedian $123 · 10th–90th $71–$3630%10%10th90th$123$50.0$100.0$200.0$500.0

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
$57.54 / $63.10 / $63.10
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$66.07 / $120.23 / $436.52
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$112.20 / $112.20 / $112.20
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $83.18 / $112.20
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $147.91 / $190.55
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$190.55 / $199.53 / $199.53
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $144.54 / $218.78
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$194.98 / $199.53 / $204.17
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$144.54 / $204.17 / $239.88
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$74.13 / $89.13 / $102.33
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $89.13 / $147.91