go back

Alaska rates for HCPCS L4397

Static or dynamic ankle foot orthosis, including soft interface material, adjustable for fit, for positioning, may be used for minimal ambulation, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.90 / $166.20 / $212.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$127.07 / $127.07 / $127.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.76 / $92.76 / $92.76
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$132.06 / $132.06 / $132.06
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$184.32 / $194.02 / $582.05
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.89 / $169.89 / $189.47
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.53 / $189.47 / $390.75
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$132.06 / $132.06 / $132.06
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$135.91 / $161.33 / $390.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.80 / $185.53 / $242.00