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Arkansas 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
Facility
Modifier
Low / Median / High Price
$113.01 / $113.01 / $113.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.87 / $113.01 / $132.06
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.66 / $162.66 / $162.66
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$219,999.78 / $539,999.46 / $949,999.05
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.53 / $232.32 / $258.13
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$197.31 / $203.34 / $203.34
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$197.31 / $197.31 / $264.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.02 / $127.07 / $162.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.76 / $92.76 / $127.07
Qualchoice
Facility/Professional
Professional
Modifier
Low / Median / High Price
$187.06 / $187.06 / $187.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.50 / $96.91 / $142.66