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Maine 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
$94.36 / $125.14 / $125.14
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$183.36 / $237.56 / $440.36
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.31 / $114.31 / $115.83
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 / $127.07
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.92 / $166.92 / $166.92
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.90 / $125.14 / $129.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.56 / $102.85 / $236.52