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West Virginia 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
$101.94 / $101.94 / $101.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.03 / $101.94 / $121.24
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$197.31 / $236.77 / $303.29
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.12 / $244.01 / $457.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.02 / $127.07 / $238.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.76 / $92.76 / $967.52
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.41 / $125.41 / $135.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.67 / $107.00 / $164.07