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Vermont 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
$104.88 / $121.02 / $136.02
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.80 / $166.80 / $166.80
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
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.02 / $127.07 / $127.07
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.76 / $92.76 / $92.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.56 / $137.16 / $248.22