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Texas 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
$89.13 / $89.13 / $93.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $104.71 / $186.21
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $154.88 / $213.80
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,162.28 / $3,548.13 / $4,265.80
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $97.72 / $97.72
Baylor Scott & White
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $162.18 / $194.98
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.89 / $125.89 / $125.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.15 / $125.89 / $125.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $93.33 / $125.89
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$933.25 / $933.25 / $933.25
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,479.11 / $1,479.11
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.33 / $141.25 / $269.15
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $112.20 / $199.53
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $125.89 / $125.89
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $77.62 / $77.62
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.33 / $181.97 / $302.00
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $93.33 / $125.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.10 / $89.13 / $208.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $112.20 / $141.25
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.93 / $208.93 / $208.93