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Nationwide rates for HCPCS L4631

Ankle-foot orthosis (AFO), walking boot type, varus/valgus correction, rocker bottom, anterior tibial shell, soft interface, custom arch support, plastic or other material, includes straps and closures, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$925.23 / $933.35 / $1,015.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$842.83 / $938.85 / $1,234.11
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,725.49 / $1,953.77 / $3,420.10
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,041.95 / $1,124.88 / $1,505.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,037.25 / $1,037.25 / $1,037.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$757.19 / $1,037.25 / $1,105.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$685.43 / $882.18 / $1,393.99