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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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.00 / $102.00 / $102.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.25 / $112.90 / $163.69
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$202.19 / $222.41 / $367.99
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$185.98 / $188.04 / $248.69
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$145.46 / $242.63 / $432.69
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$202.19 / $212.30 / $284.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$127.07 / $427.79 / $843.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.76 / $336.74 / $382.66
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.00 / $157.85 / $232.52
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.02 / $202.19 / $242.63
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$121.88 / $202.19 / $939.42
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.12 / $107.65 / $224.88
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $62.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.00 / $161.75 / $232.52
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.02 / $202.19 / $242.63
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$202.19 / $311.14 / $539.99
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$127.07 / $394.90 / $939.42
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.76 / $127.07 / $1,006.48
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$202.19 / $202.19 / $202.19
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$202.19 / $202.19 / $202.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.95 / $105.84 / $262.85