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Idaho 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
$77.62 / $130.94 / $169.89
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 / $210.77
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$132.06 / $167.60 / $194.02
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$174.62 / $194.02 / $194.02
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $143.18 / $170.52
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.89 / $189.47 / $284.20
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$135.81 / $140.51 / $203.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.67 / $89.95 / $151.87