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Arizona 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
Professional
Modifier
Low / Median / High Price
$794.33 / $933.25 / $1,621.81
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,380.38 / $1,819.70
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.44 / $1,348.96 / $2,818.38
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $2,187.76 / $4,265.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $1,047.13 / $1,047.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $758.58 / $1,047.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$977.24 / $1,202.26 / $4,365.16
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $831.76 / $1,659.59
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$562.34 / $1,071.52 / $1,778.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $831.76 / $1,258.93