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Rhode Island 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
$90.08 / $112.90 / $136.02
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$291.48 / $393.69 / $466.08
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.01 / $112.95 / $184.02
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
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $112.90 / $171.42