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Wisconsin 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 $204 · 10th–90th $191$3720%50%10th90th$204Professionalmedian $126 · 10th–90th $79$3240%10%20%10th90th$126$0.2$1.0$5.0$20.0$100.0$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $102.33 / $102.33
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $104.71 / $213.80
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$204.17 / $204.17 / $338.84
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$190.55 / $190.55 / $229.09
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$245.47 / $245.47 / $323.59
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$125.89 / $457.09 / $1,023.29
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $295.12 / $389.05
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $165.96 / $239.88
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$194.98 / $223.87 / $245.47
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$109.65 / $204.17 / $933.25
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$91.20 / $107.15 / $229.09
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $61.66 / $70.79
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$177.83 / $239.88 / $501.19
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$204.17 / $309.03 / $562.34
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$125.89 / $407.38 / $933.25
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $186.21 / $1,000.00
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$63.10 / $104.71 / $204.17
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $104.71 / $407.38