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Utah 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

Facilitymedian $95 · 10th–90th $78–$2000%20%40%10th90th$95Professionalmedian $141 · 10th–90th $78–$7080%10%10th90th$141$50.0$100.0$200.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$77.62 / $77.62 / $77.62
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $141.25 / $707.95
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $93.33 / $125.89
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$34.67 / $147.91 / $186.21
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$190.55 / $199.53 / $199.53
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $144.54 / $218.78
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$194.98 / $199.53 / $204.17
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$147.91 / $204.17 / $239.88
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$74.13 / $89.13 / $95.50
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $89.13 / $154.88