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Missouri 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
$27.86 / $109.51 / $151.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.57 / $106.64 / $160.66
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$133.46 / $145.52 / $232.82
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.02 / $203.72 / $895.60
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.72 / $120.05 / $166.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.02 / $127.07 / $127.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.76 / $92.76 / $92.76
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$105.26 / $164.92 / $939.42
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.95 / $96.80 / $235.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.56 / $96.80 / $164.32