go back

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
$89.13 / $114.82 / $134.90
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $165.96 / $165.96
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
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $190.55 / $239.88
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.13 / $89.13 / $112.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $162.18 / $426.58