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Nebraska 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
$123.73 / $123.73 / $123.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.90 / $123.73 / $275.00
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$145.52 / $145.52 / $164.92
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.52 / $187.58 / $189.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.02 / $213.42 / $213.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$207.61 / $234.38 / $329.11
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$123.73 / $212.37 / $939.42
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.87 / $96.80 / $197.45
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$212.80 / $213.42 / $273.92
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$203.19 / $259.42 / $439.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.17 / $96.80 / $141.12