go back

Massachusetts 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
$89.13 / $89.13 / $89.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $114.82 / $263.03
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.98 / $213.80 / $933.25
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $151.36 / $213.80
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $489.78 / $1,479.11
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $186.21 / $245.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.15 / $125.89 / $125.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $93.33 / $125.89
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.18 / $4,897.79 / $9,772.37
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $181.97 / $275.42
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $128.82 / $128.82
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.98 / $213.80 / $933.25
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $151.36 / $213.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.14 / $100.00 / $245.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $128.82 / $181.97