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Arkansas rates for HCPCS L4631

Ankle Foot Orthosis 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
$995.85 / $995.85 / $995.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$749.00 / $995.85 / $996.99
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,433.34 / $1,433.34 / $1,433.34
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$219,999.78 / $539,999.46 / $949,999.05
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,546.71 / $2,047.12 / $2,274.58
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,807.78 / $1,807.78 / $1,875.14
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,875.14 / $1,875.14 / $1,875.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,037.25 / $1,037.25 / $1,433.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$757.19 / $1,037.25 / $1,399.74
Qualchoice
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,648.34 / $1,648.34 / $1,648.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$552.10 / $833.05 / $1,313.43