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Tennessee 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
$91.48 / $91.48 / $99.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.79 / $96.56 / $171.22
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.38 / $225.00 / $274.51
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$121.15 / $183.01 / $183.01
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
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$317.70 / $939.42 / $939.42
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,006.48 / $1,006.48 / $1,479.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.63 / $101.44 / $141.12