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Montana 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
$112.90 / $112.90 / $559.82
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$196.03 / $196.03 / $196.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$127.07 / $210.77 / $210.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.07 / $210.77 / $210.77
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$127.07 / $200.73 / $210.77
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.19 / $161.69 / $210.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.67 / $89.95 / $142.66